自然循環の冷凍胚移植の再検討:体系的なレビューとメタ解析
Murat Erden1,2, Sezcan Mumusoglu3, Esra Uyanik1,4
1Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
Human reproduction update
|February 14, 2026
まとめ
自然サイクル冷凍胚移植 (NC FET) は潜在的な利点がありますが,改変NC FETや自然増殖期 (NPP) FETのような改変プロトコルは,スケジューリングの柔軟性を向上させる可能性があります. ルテアルフェーズサポート (LPS) は,真のNC FETでは有益ですが,修正NC FETでは有益ではありません.
科学分野:
- 生殖内分泌学 生殖内分泌学
- 助産生殖技術 (APT) とは
- 臨床試験分析 臨床試験分析について
背景:
- 凍結胚移植 (FET) のための最適な子宮内膜の準備は調査中であり,自然サイクル (NC) FETは,潜在的母体および生理周期の利点に注目されています.
- 観測データはNC FETを支持しているが,物流上の課題は,その広範な採用を制限している.
- 自然増殖期 (NPP) FETプロトコルは,生理学的利点と改善されたスケジューリングの柔軟性を組み合わせています.
研究 の 目的:
- 異なる自然サイクルFET実行戦略の生殖成果を体系的にレビューし,評価する.
- 自然増殖期 (NPP) FETを他のFETプロトコルと比較する.
- 様々なNC FETプロトコルにおけるルテアル相サポート (LPS) の影響を評価する.
主な方法:
- 2024年11月までの主要データベース (MEDLINE,Embase,Global Health,Cochrane Library) で,包括的な文献検索を実施しました.
- 対象となった研究には,ランダム化比較試験,非ランダム化介入研究,観察研究が含まれていた.
- キーワードには"冷凍胚移植"",自然サイクル"",妊娠"",生産"",生育"など,言語やフィルターによる制限のない"出産"が含まれていた.
主要な成果:
- 真のNC FETにおける排卵周期は,ルテイン化未破裂の卵泡周期と比較して,より高い生育率 (LBRs) と関連していた (非常に低い確実性の証拠).
- 真NC FETでは,性プロゲステロンによる性相サポート (LPS) がLBRを改善したが,改変NC FETではそうではなかった (中等確実性証拠).
- 自然増殖期 (NPP) FETは,ホルモン置換療法 (HRT) FETと比較して,より高いLBRを示した (非常に低い確実性の証拠).
結論:
- 修正されたNCとNPPのFET戦略は,限られた高品質の証拠にもかかわらず,生理学的利点とスケジューリングの便利さのバランスをとる可能性があります.
- ルーティンLPSは,true-NC FETには推奨されますが,modified-NC FETには推奨されません.
- NPP FETは,生殖の成果を損なうことなく,スケジュールの強化を約束し,さらなる高品質の研究を正当化しています.
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