Effect of artificial cycle with or without GnRH-a pretreatment on pregnancy and neonatal outcomes in women with PCOS after frozen embryo transfer: a propensity score matching study

Abstract

Background In frozen embryo transfer (FET), there is limited consensus on the best means of endometrial preparation in terms of the reproductive outcomes in women with polycystic ovary syndrome (PCOS). The present study aimed to compare the pregnancy and neonatal outcomes following artificial cycle FET (AC-FET) with or without gonadotropin-releasing hormone agonist (GnRH-a) pretreatment among women with PCOS. Methods A total of 4503 FET cycles that satisfied the inclusion criteria were enrolled in this retrospective cohort study between 2015 and 2020. The GnRH-a group received GnRH-a pretreatment while the AC-FET group did not. Propensity score matching (PSM) method and multivariate logistic regression analysis were performed to adjust for potential confounding factors. Results After PSM, women in the GnRH-a group suffered a significantly lower miscarriage rate (11.2% vs. 17.1%, P = 0.033) and a higher live birth rate (LBR) compared with those in the AC-FET group (63.1% vs. 56.8%, P = 0.043). No differences were observed in the rates of biochemical pregnancy, clinical pregnancy and ectopic pregnancy between the two groups. A higher mean gestational age at birth was observed in the GnRH-a group than in the AC-FET group (39.80 ± 2.01 vs. 38.17 ± 2.13, P = 0.009). The incidence of neonatal preterm birth (PTB) in the GnRH-a group was lower than that in the AC-FET group (7.4% vs. 14.9%, P = 0.009). Singleton newborns conceived after GnRH-a group were more likely to be small for gestational age (SGA) than those born after AC-FET group (16.4% vs. 6.8%, P = 0.009). However, no significant differences were found between the two groups in terms of mean birthweight, apgar score, the rates of macrosomia, large for gestational age and low birth weight. Conclusion(s) In women with PCOS who underwent AC-FET, GnRH-a pretreatment was significantly associated with a higher live birth rate and a reduced risk of neonatal PTB. However, there was a concomitant increase in the risk of developing SGA babies.

Obstetric and neonatal outcomes after programmed frozen embryo transfer with or without GnRH agonist for polycystic ovary syndrome: secondary analysis results from a randomized controlled trial

“…However, GnRH-a pretreatment for programmed FET cycles increased the chances of LBW singleton deliveries, even after adjusting for maternal age, gestational age, neonate sex, and other important variables related to infertility. This result is in accordance with the findings of Wang et al 17 who showed an increased risk for SGA in the GnRH-a pretreatment group. Twin pregnancies were associated with significantly higher risks of both maternal and neonatal complications, but the total prevalence was similar between the groups for twin pregnancies.…”

“…In a retrospective study, Liu et al 16 reported a higher risk for PTB after programmed FET with GnRH-a pretreatment among women with PCOS, but other important complications were not reported. A retrospective study using propensity score matching by Wang and colleagues 17 found a higher risk for SGA singleton birth following GnRH-a pretreatment cycles when compared with cycles without pretreatment for women with PCOS. In addition, all previous studies on the obstetrical and neonatal complications among women with PCOS have been retrospective and observational and included only singleton pregnancies.…”

STROBE-GnRHa pretreatment in frozen-embryo transfer cycles improves clinical outcomes for patients with persistent thin endometrium: A case-control study

“…[28,29] Recent studies also have found that patients with unexplained repeated implantation failure, polycystic ovary syndrome, and high serum autoantibody levels could obtain better clinical outcomes with the GnRHa pretreatment. [30–32] These above studies had the same trend of improvement on clinical outcomes with GnRHa pretreatment. However, due to the patient profile and GnRHa utilization in various studies vary largely, the direct comparison of the absolute number in detail is unreasonable.…”

Comparison of different endometrial preparation protocols in frozen-thawed embryo transfer cycles in women with polycystic ovary syndrome

“…Wang et al (24) reported the better outcomes to HRT protocols. According to Niu et al (25), both letrozole and Human Menopozal Gonadotropin (HMG) ovulation induction regimen had an association with more acceptable pregnancy results than the HRT regimen, such as a lower pregnancy loss rate, and a higher livebirth rate among the PCOS patients undergoing frozen single-blastocyst transfer.…”