Abstract
BackgroundThe ideal protocols of endometrial preparation for polycystic ovary syndrome (PCOS) patients are lacking and need further declaration. Our objective was to compare the clinical outcomes of frozen-thawed embryo transfer (FET) with and without pretreatment gonadotropin-releasing hormone agonist (GnRHa) in PCOS patients.MethodsIn this retrospective cohort study, we used propensity score matching (PSM) to compare the live birth rate between patients who underwent FET with hormone replacement treatment (HRT) and patients with GnRHa pretreatment (GnRHa + HRT). Patients using GnRHa + HRT (n = 514) were matched with 514 patients using HRT.ResultsThe live birth rate was higher in the GnRHa + HRT group compared with the HRT group with no significant difference (60.12% vs 56.03%, p = 0.073). The clinical pregnancy rate (75.29% vs 70.62%), miscarriage rate (14.20% vs 13.81%) and ectopic pregnancy rate (0.39% vs 0.19%) were similar between the two groups. The preterm birth rate in GnRHa + HRT was higher than HRT (20.23% vs 13.04%). No difference was found in live birth between GnRHa +HRT and HRT before adjusting for covariates (crude OR 1.22, 95%CI, 0.99–1.51, p = 0.062) and after PSM (OR 1.47, 95%CI, 0.99–2.83, p = 0.068). In addition, there is a marginally difference after adjusting for covariates (aOR 1.56, 95%CI, 1.001–2.41, p = 0.048), this finding with p-value close to 0.05 represent insufficient empirical evidence. Similar results were obtained after propensity score matching in the entire cohort.ConclusionsGnRHa pretreatment could not improve the live birth rate in women with PCOS.
Highlights
The ideal protocols of endometrial preparation for polycystic ovary syndrome (PCOS) patients are lacking and need further declaration
The freeze-all policy of cryopreserving all embryos produced in an IVF cycle to transfer later has become more appropriate when there is a risk of ovarian hyperstimulation syndrome (OHSS), high progesterone level, preimplantation genetic testing (PGT), Liu et al BMC Pregnancy and Childbirth (2021) 21:835 abnormal endometrium, and other conditions
No difference was found in live birth between gonadotropin-releasing hormone agonist (GnRHa) +hormone replacement treatment (HRT) and HRT before adjusting for covariates and after propensity score matching (PSM)
Summary
The ideal protocols of endometrial preparation for polycystic ovary syndrome (PCOS) patients are lacking and need further declaration. Our objective was to compare the clinical outcomes of frozen-thawed embryo transfer (FET) with and without pretreatment gonadotropin-releasing hormone agonist (GnRHa) in PCOS patients. Polycystic ovary syndrome (PCOS) is a common endocrine syndrome and affects between 8 and 18% of women [1]. Studies have demonstrated comparable outcomes between fresh and frozen-thawed embryo transfer (FET) [3,4,5]. The altered hormone level may adversely affect endometrial receptivity in fresh embryo transfer. Protocols described in FET include natural cycle, hormone replacement treatment (HRT) cycle, and down-regulation with GnRH agonists (GnRHa). HRT with and without GnRHa becomes the most common method of endometrial preparation for PCOS patients. The GnRHa cycles eliminate the possible detrimental role of high LH on the oocyte quality and implantation rate
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