Hormone replacement therapy may increase the risk of early miscarriage
during frozen embryo transfer cycles in patients with a history of
cesarean section: a retrospective cohort study
Abstract
Objective: To investigate the efficacies of three cycle regimens in
women receiving FET with a history of CS: natural cycle (NC) treatment,
hormone replacement therapy (HRT) and treatment with
gonadotropin-releasing hormone agonist (GnRH-a) + HRT). Design:
Retrospective cohort study. Setting: University-affiliated center.
Population: Patients (N = 6,159) with a history of CS who fulfilled the
inclusion criteria were enrolled in the study from January 2014 to
December 2019. Methods: Reproductive outcomes of patients in the NC (n =
4,306) versus HRT (n = 1,007) versus GnRH-a + HRT groups (n = 846) were
compared. Main Outcome Measure: The main outcome measure was the live
birth rate per embryo transfer (ET). Results: The unadjusted odds of the
miscarriage rate of singleton pregnancies were also significantly higher
in the HRT-group compared with the NC-group (25.5% versus 20.4%,
respectively). After adjusting for possible confounding factors, the
early miscarriage rate and the miscarriage rate of singleton pregnancies
remained significantly higher in the HRT-group than the NC-group. The
clinical pregnancy rates in the NC-, HRT- and GnRH-a + HRT-groups of
women with a history of CS was 48.8%, 48% and 47.1%, respectively,
and the live birth rates were 37%, 34.1% and 35.7%, respectively.
Conclusion(s): In women undergoing FET with a history of CS, HRT for
endometrial preparation was associated with a higher early miscarriage
rate, albeit after statistical adjustment for confounding factors.
Funding: The National Science Foundation of China (81501328). Key Words:
Caesarean section, endometrial preparation, frozen embryo transfer,
miscarriage