Research question

Is there a difference in live birth rate between a freeze-only strategy and fresh embryo transfer, and what is the effect of varying progesterone concentrations on the day of human chorionic gonadotrophin (HCG) administration?

Design

A secondary analysis of data from three randomized trials comparing the live birth rate after elective frozen versus fresh embryo transfer, which respectively enrolled 1508 women with polycystic ovary syndrome, 2157 ovulatory women who underwent cleavage-stage embryo transfer and 1650 ovulatory women who underwent single blastocyst transfer. Women were randomly assigned to the frozen or fresh embryo transfer group in the original trials. The primary outcome was live birth rate after the initial embryo transfer.

Results

The live birth rate after a freeze-only strategy was consistently higher than fresh embryo transfer at any progesterone concentration on the day of HCG administration. Nonetheless, the between-group difference in live birth rate after frozen versus fresh embryo transfer was greater in women with progesterone concentrations ≥1.14 ng/ml (52.7% versus 37.3%, odds ratio (OR) 1.88, 95% confidence interval (CI) 1.55–2.27, P = 7.89 × 10^–11) than in women with progesterone concentrations <1.14 ng/ml (53.3% versus 48.1%, OR 1.23, 95% CI 1.08–1.41, P = 0.002). In women with progesterone concentration ≥1.14 ng/ml, frozen embryo transfer also resulted in higher rates of conception and clinical pregnancy than fresh embryo transfer.

Conclusion

In women with normal or high ovarian response, a freeze-only strategy resulted in a higher live birth rate than fresh embryo transfer, irrespective of progesterone concentration. Moreover, women with progesterone concentration ≥1.14 ng/ml may benefit more from a freeze-only strategy.

中文翻译：

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在考虑孕酮浓度的三项随机试验中，仅冷冻策略与新鲜胚胎移植后活产。

研究问题

仅冷冻策略和新鲜胚胎移植之间的活产率是否存在差异？不同孕酮浓度对人绒毛膜促性腺激素 (HCG) 给药当天有何影响？

设计

三项随机试验数据的二次分析比较了选择性冷冻与新鲜胚胎移植后活产率，分别招募了 1508 名多囊卵巢综合征女性、2157 名接受卵裂期胚胎移植的排卵女性和 1650 名接受单囊胚移植的排卵女性转移。在最初的试验中，女性被随机分配到冷冻或新鲜胚胎移植组。主要结果是初始胚胎移植后的活产率。

结果

在施用 HCG 当天，在任何孕酮浓度下，仅冷冻策略后的活产率始终高于新鲜胚胎移植。尽管如此，在孕酮浓度≥1.14 ng/ml 的女性中，冷冻胚胎移植与新鲜胚胎移植后活产率的组间差异更大（52.7% 对 37.3%，优势比 (OR) 1.88，95% 置信区间 (CI) 1.55–2.27, P  = 7.89 × 10 ^–11 ) 与孕酮浓度 <1.14 ng/ml 的女性相比（53.3% 对 48.1%，OR 1.23，95% CI 1.08–1.41，P  = 0.002）。在孕酮浓度≥1.14 ng/ml 的女性中，冷冻胚胎移植也导致比新鲜胚胎移植更高的受孕率和临床妊娠率。

结论

在卵巢反应正常或高的女性中，无论孕酮浓度如何，仅冷冻策略的活产率都高于新鲜胚胎移植。此外，孕酮浓度≥1.14 ng/ml 的女性可能会从仅冷冻策略中获益更多。