摘要
目的初步探讨冷冻胚胎复苏周期中已冻存的低质量囊胚与高质量卵裂期胚胎的优先移植顺序。方法回顾性分析了郑州大学第三附属医院生殖医学中心2015年11月至2018年5月期间3677个冻融胚胎移植(FET)周期的临床资料。根据移植胚胎发育时期、质量及移植胚胎数的不同分为5组:单非优质囊胚组(A组)、单优质囊胚组(B组)、第3日(D3)双优质胚胎组(C组)、D3优+非优质胚胎组(D组)、D3双非优质胚胎组(E组)。每组再根据患者的年龄分为3个亚组:<35岁、35~37岁和>37岁。主要观察指标为活产率,次要观察指标为临床妊娠率、植入率和多胎率。结果 D3双胚胎移植组(C^E组)植入率均显著低于单囊胚组(A、B组)(P均<0.05),而多胎妊娠率均显著高于单囊胚组(P均<0.01)。C组与A组相比,临床妊娠率差异无统计学意义(P>0.05);患者年龄<35岁时,活产率显著升高(P=0.003),35~37岁组及>37岁组活产率的差异无统计学意义。D组与A组相比,患者年龄<35岁组及35~37岁组,临床妊娠率及活产率差异均无统计学意义(P>0.05);患者年龄>37岁时,临床妊娠率显著降低(P=0.018),活产率降低,但差异无统计学意义(P>0.05)。E组与A组相比,所有年龄段的临床妊娠率、活产率均降低;当患者年龄<35岁及>37岁时差异均有统计学意义(P<0.05),患者年龄为35~37岁时,差异无统计学意义(P>0.05)。年龄和移植胚胎的种类均是活产的独立影响因素。调整年龄对活产的影响后,与A组相比,B组(OR=1.311,95%CI=1.083~1.586,P=0.005)、C组(OR=1.322,95%CI=1.092~1.601,P=0.004)、E组(OR=0.616,95%CI=0.468~0.809,P=0.001)对活产率的影响差异均有统计学意义,而D组(OR=1.139,95%CI=0.914~1.420,P=0.247)对活产的影响程度与A组相比,差异无统计学意义。结论综合考虑多胎妊娠及活产等因素,冷冻胚胎复苏周期最优的移植顺序可能是单优质囊胚>单非优质囊胚>D3双优质胚胎>D3优+非优质胚胎>D3双非优质胚胎。
Objective To preliminarily explore the priority order of transfer of frozen low-quality blastocyst and high-quality cleavage embryos in the recovery frozen-thawed embryo transfer(FET)cycle of frozen embryos.Methods In this retrospective study,3677 in vitro fertilization-embryo transfer(IVF-ET)cycles were reviewed in Reproductive Medicine Center of the Third Affiliated Hospital of Zhengzhou University from November 2015 to May 2018.According to the stage of embryo development,quality and number of embryos transferred,the embryos were divided into five groups:single-non-high-quality blastocyst group(group A),single-high-quality blastocyst group(group B),day 3(D3)double-high-quality embryo group(group C),D3 high-quality plus non-high-quality embryo group(group D)and D3 double-non-high-quality embryo group(group E).According to the age of the patients,they were divided into three subgroups,<35 years old,35-37 years old and>37 years old.The main observation indicator was live birth rate,and the secondary observation indicators were clinical pregnancy rate,implantation rate,and multiple birth rate.Results The implantation rates of double D3 embryos transfer groups(groups C-E)were significantly lower than those of single blastocyst groups(groups A and B)(all P<0.05),while the multiple pregnancy rates were significantly higher than those of single blastocyst groups(all P<0.01).There was no significant difference in clinical pregnancy rate between group C and group A(P>0.05).Live birth rate increased significantly when patients were younger than 35 years old(P=0.003),but there was no significant difference when patients were older than 35 years old.There was no significant difference in clinical pregnancy rate and live birth rate between group D and group A when patients were younger than 38 years old.When the patient was over 37 years old,the clinical pregnancy rate of group D was lower significantly(P=0.018),but there was no significant difference in the live birth rate(P>0.05).The clinical pregnancy rate and the live birth rate of group E were lower than those of group A.The difference was significant when the age of the patients was less than 35 years and more than 37 years(all P<0.01).There was no significant difference when the age of the patients was 35-37 years(P>0.05).Age and the type of embryos transferred were independent factors affecting live birth.After adjusting the effect of age on live birth,compared with group A,the effects of group B(OR=1.311,95%CI=1.083-1.586,P=0.005),group C(OR=1.322,95%CI=1.092-1.601,P=0.004),group E(OR=0.616,95%CI=0.468-0.809,P=0.001)on the live birth rate were significantly different,while the effects of group D(OR=1.139,95%CI=0.914-1.420,P=0.247)on the live birth rate was not significantly different from those of group A.Conclusion Considering multiple pregnancies and live births,the optimal transplantation sequence of frozen embryo transfer cycle may be single-high-quality blastocyst,single-non-high-quality blastocyst,D3 double-high-quality embryo,D3 high-quality plus non-high-quality embryo and D3 double-non-high-quality embryo.
作者
刘景
孔红娇
管一春
赵君亮
李嘉恒
张玉超
刘晓阳
李怡梦
王兴玲
Liu Jing;Kong Hongjiao;Guan Yichun;Zhao Junliang;Li Jiaheng;Zhang Yuchao;Liu Xiaoyang;Li Yimeng;Wang Xingling(Reproductive Medicine Center,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2020年第6期454-460,共7页
Chinese Journal of Reproduction and Contraception
基金
河南省医学科技攻关计划项目(201602133)。
关键词
冻融胚胎移植
移植策略
活产
临床妊娠
Frozen-thawed embryo transfer
Transfer strategy
Live birth
Clinical pregnancy
