Abstract
Background: The optimal means to prepare the endometrial preparation for PCOS patients is a topic of ongoing controversy. Our objective was to compare the clinical outcomes of frozen-thawed embryo transfer (FET) with and without pretreatment gonadotropin-releasing hormone agonist (GnRHa) in polycystic ovary syndrome (PCOS) patients. Methods: In this retrospective cohort study, we evaluated 1638 consecutive cycles between June 2014 and December 2017 in the Assisted Reproduction Center of Northwest Women’s and Children’s Hospital. The patients who underwent FET were assigned to two groups as follows: hormone replacement treatment (HRT) group, comprising 1115 cycles; HRT with GnRHa pretreatment (GnRHa + HRT), comprising 523 cycles. Patients using GnRHa + HRT (n=519) were matched with 519 patients using HRT. Results: The live birth rate was higher in the GnRHa + HRT group compared with the HRT group with no significant difference (60.4% vs 55.5%, p=0.062). The clinical pregnancy rate (72.74% vs 75.33%), miscarriage rate (14.26% vs 13.96%) and ectopic pregnancy rate (0.36% vs 0.38%) were similar between the two groups. The preterm birth rate in HRT was lower than GnRHa + HRT (14.08% vs 20.08%). There were no significant interactions in any of the subgroups (p>0.05 for all comparisons). In the unadjusted model and adjusted model, the live birth rate was comparable between GnRHa + HRT and HRT group (OR 1.22, 95%CI, 0.99-1.51, p=0.062; aOR 1.56, 95%CI, 1.001-2.41, p=0.048). Similar results were obtained after propensity score matching in the entire cohort. Conclusions: GnRHa pretreatment could not improve the live birth rate in women with PCOS.
Natural cycle frozen-thawed embryo transfer in young women with regular menstrual cycles increases the live-birth rates compared with hormone replacement treatment: a retrospective cohort study
