Analysis of the influencing factors of embryo quality and pregnancy outcomes in frozen-thawed embryo transfer cycle in polycystic ovary syndrome patients北大核心CSCD

Objective To explore the influencing factors of embryos quality during the cycle of in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) and pregnancy outcomes of frozen-thawed embryo transfer (FET) in patients with polycystic ovary syndrome (PCOS). Methods A retrospective case-control study design was used to analyze patients who received IVF/ ICSI treatment at the Reproductive Medicine Center of Tianjin Central Obstetrics and Gynecology Hospital from January 2015 to December 2019, underwent whole embryo cryopreserved and performed the first FET. The 1233 cycles included were divided into control group (n=561) and PCOS group (n=672) according to PCOS diagnosis. The general clinical characteristics, laboratory-related indicators and pregnancy outcomes of patients between the two groups were compared, and the affecting factors of the late miscarriage rate were analyzed by multivariate logistic regression. Results 1) In terms of the general clinical characteristics between the two groups, the differences of duration of infertility (3.95±2.01) years vs. (4.84±2.91) years, P=0.007], body mass index (BMI) (21.96±2.52) kg/m2 vs. (23.96±3.50) kg/m2, P<0.001], basal luteinizing hormone (4.71±2.38) mU/L vs. (8.18±5.40) mU/L, P<0.001], basal estradiol (45.49±31.80) ng/L vs. (56.67±54.17) ng/L, P=0.032], basal testosterone (42.80±13.45) ng/L vs. (53.45±38.67) ng/L, P=0.001], gonadortopin initial used dosage (230.80±54.07) U vs. (192.11±53.79) U, P<0.001] were statistically significant. The endometrium preparation plan in the FET cycle, more PCOS group patients received hormone replacement treatment 64.1% (431/672) vs. 26.6% (149/561)], while more patients in control group received natural cycle transplantation 73.4% (412/561) vs. 35.9% (241/672)], and the differences were statistically significant (all P<0.001). 2) In terms of the laboratory results, the number of oocytes retrieved in PCOS group (23.36±9.53) was higher than that in control group (20.32±8.81, P=0.002). The number of high-quality embryos and the rate of high-quality embryos in PCOS group 2.94±3.13; 33.3% (2016/6048)] were lower than those in control group 4.17±3.65, P=0.034; 46.3% (2339/ 5049), P<0.001], and the differences were statistically significant. 3) In the pregnancy outcomes, the high-quality embryo transfer rate and the biochemical pregnancy rate in control group were higher than those in PCOS group 71.0% (743/1046) vs. 59.3% (761/1284), P<0.001; 7.3% (41/561) vs. 4.5% (30/672), P=0.033], and the late miscarriage rate in PCOS group 10.3% (43/418)] was higher than that in control group 4.3% (16/326), P=0.002]. 4) Logistic regression analysis was performed on the influencing factors of late miscarriage. After correcting the confounding factors, PCOS (OR=2.573, 95% CI=1.270-5.212, P=0.009) and maternal high BMI (OR=1.080, 95% CI=0.991-1.176, P=0.031) were the risk factors for late miscarriage. Conclusion The number of high-quality embryos and the rate of high-quality embryos in PCOS patients were lower than those in non-PCOS patients. PCOS and high BMI were risk factors for late miscarriage in patients. Improving endocrine disorders and weight control in PCOS patients before fertility treatment is of positive significance for improving the pregnancy outcome of patients. © 2022 Chinese Medical Journals Publishing House Co.Ltd. All rights reserved.