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Assessing the effect on pregnancy outcomes of artificial frozen embryo transfer cycles in women with advanced age following oocyte donation
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Objetivo do estudo: O protocolo ideal de preparação endometrial para transferência de embriões congelados ainda não foi determinado. Estudos mostram resultados potencialmente melhores após a transferência em ciclo natural em comparação com ciclo artificial. No entanto, não é conhecido se essa associação se mantém em mulheres de idade avançada. O principal objetivo deste estudo foi avaliar se a idade poderia ser um preditor de pior desfecho após a transferência de embriões congelados em ciclo natural (versus ciclo artificial) num modelo de ovodoação. Métodos: Este estudo de coorte retrospectivo e multicêntrico, incluiu mulheres que foram submetidas a pelo menos uma transferência de um único embrião no estádio de blastocisto num ciclo de ovodoação realizado entre janeiro de 2010 e dezembro de 2019. Dividimos a amostra em dois grupos de estudo: ciclo natural e ciclo artificial. O objetivo principal do estudo foi comparar as taxas de nados-vivos entre os dois grupos. Os desfechos secundários de nosso estudo incluíram 1) taxa de aborto espontâneo, 2) taxa de gravidez clínica e 3) taxa de gravidez bioquímica. Resultados: No total foram analisadas 62530 transferências de embriões. Os resultados mostraram que apesar do ciclo artificial apresentar uma taxa de gravidez bioquímica (62.81% vs 58.72%; OR 0.842 CI 0.7293-0.895) e uma taxa de gravidez clínica superior (53.95% vs 50.52%; OR 0,872 CI 0.821-0.925), está associado a uma maior taxa de aborto (28.95% vs 24.32%; OR 0.788 CI 0.720-0.862) o que resulta numa menor taxa de nados vivos (41.60% vs 42.56%; OR 1.040 CI 0.979-1.105) que é estatisticamente significativa após ajuste de fatores de confundimento (OR 1.303 CI 1.203-1.412). A interação com a idade da mulher não foi estatisticamente significativa (aOR 1,015, IC 95% 0,994-1,036), rejeitando assim a hipótese de que eventuais diferenças entre os ciclos possam ser modificadas de acordo com a idade da recetora. Conclusão: Este estudo mostrou que o ciclo natural parece ser ligeiramente superior, o que está de acordo com os achados de estudos anteriores. Mostrou ainda, que, as diferenças entre as duas preparações endometriais não são modificadas pela idade da mulher.
Aim of the study: The optimal frozen embryo transfer (FET) preparation protocol is yet to be determined. Data have shown potentially better outcomes after FET in natural cycle (NC-FET) when compared to artificial cycle (AC-FET). However, it remains unknown whether this association still exists in women in later reproductive years. The main propose of this study was to assess whether female age could be a predictor of worse outcome after transferring frozen embryos in NC (versus AC) in women receiving donated oocytes. Methods: This retrospective, multicentre, cohort study included women who underwent at least one FET of a single embryo at blastocyst stage from an oocyte donation cycle performed between January 2010 and December 2019. We divided the cohort into two study groups: NC-FET and AC-FET. The main objective of our study was to compare live birth delivery rates (LBR). The secondary outcomes of our study included 1) spontaneous miscarriage rates, 2) clinical pregnancy rate (CPR) and 3) human chorionic gonadotropin (hCG) positive pregnancy. Results: In total 62530 embryo transfers were analysed. Results showed that despite higher hCG positive pregnancy (62.81% vs 58.72%; OR 0.842 CI 0.7293-0.895) and higher CPR (53.95% vs 50.52%; OR 0,872 CI 0.821-0.925), AC were associated also to a higher miscarriage rate (28.95% vs 24.32%; OR 0.788 CI 0.720-0.862) resulting in a trend towards lower LBRs with AC (41.60% vs 42.56%; OR 1.040 CI 0.979-1.105) that became significant after confounder adjustment (OR 1.303 CI 1.203-1.412). The interaction with female age was not statistically significant (aOR 1.015, 95% CI 0.994- 1.036), thus rejecting the hypothesis that any eventual differences between cycles may be modified according to the age of the recipient. Conclusion: This study showed that NC-FET is slightly better, which is in agreement with the findings of previous studies on this question. We found no evidence that the differences between the two endometrial preparations are modified by the age of the woman.
Aim of the study: The optimal frozen embryo transfer (FET) preparation protocol is yet to be determined. Data have shown potentially better outcomes after FET in natural cycle (NC-FET) when compared to artificial cycle (AC-FET). However, it remains unknown whether this association still exists in women in later reproductive years. The main propose of this study was to assess whether female age could be a predictor of worse outcome after transferring frozen embryos in NC (versus AC) in women receiving donated oocytes. Methods: This retrospective, multicentre, cohort study included women who underwent at least one FET of a single embryo at blastocyst stage from an oocyte donation cycle performed between January 2010 and December 2019. We divided the cohort into two study groups: NC-FET and AC-FET. The main objective of our study was to compare live birth delivery rates (LBR). The secondary outcomes of our study included 1) spontaneous miscarriage rates, 2) clinical pregnancy rate (CPR) and 3) human chorionic gonadotropin (hCG) positive pregnancy. Results: In total 62530 embryo transfers were analysed. Results showed that despite higher hCG positive pregnancy (62.81% vs 58.72%; OR 0.842 CI 0.7293-0.895) and higher CPR (53.95% vs 50.52%; OR 0,872 CI 0.821-0.925), AC were associated also to a higher miscarriage rate (28.95% vs 24.32%; OR 0.788 CI 0.720-0.862) resulting in a trend towards lower LBRs with AC (41.60% vs 42.56%; OR 1.040 CI 0.979-1.105) that became significant after confounder adjustment (OR 1.303 CI 1.203-1.412). The interaction with female age was not statistically significant (aOR 1.015, 95% CI 0.994- 1.036), thus rejecting the hypothesis that any eventual differences between cycles may be modified according to the age of the recipient. Conclusion: This study showed that NC-FET is slightly better, which is in agreement with the findings of previous studies on this question. We found no evidence that the differences between the two endometrial preparations are modified by the age of the woman.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022
Palavras-chave
Ciclo natural Ciclo artificial Ovoadoação Idade materna avançada Transferência de embriões congelados Obstetrícia