不同年龄患者全胚冷冻后首次冻融胚胎移植的临床策略  

Clinical strategy of the first frozen-thawed embryo transfer after cryopreservation in patients of different ages

作　　者：郑娟[1] 周黎明[1] 孙亦婷[1] 夏爱丽[1] 李洁[1] Zheng Juan;Zhou Liming;Sun Yiting;Xia Aili;Li Jie(Reproductive Center of Ningbo Women&Children Hospital,Ningbo 315000,China)

机构地区：[1]浙江省宁波市妇女儿童医院生殖中心,31500

出　　处：《中华生殖与避孕杂志》2021年第3期212-219,共8页Chinese Journal of Reproduction and Contraception

基　　金：宁波市医疗卫生品牌学科(PPXK2018-06);浙江省医药卫生科技计划项目(2019RC268)。

摘　　要：目的探讨冷冻胚胎周期不同年龄段患者如何制定移植策略。方法回顾性队列研究分析浙江省宁波市妇女儿童医院生殖中心取卵后全胚冷冻并于2018年1月至2020年4月期间首次行冻融胚胎移植患者的临床资料,根据患者的年龄分为三组,即≤30周岁组(1150个周期)、30~35周岁组(932个周期)及>35周岁组(405个周期);在每个年龄组内,再根据移植胚胎级别及移植数目分为第3日单卵裂期胚胎移植(single cleavage stage embryo transplant,SET3)亚组、第5日单囊胚移植(single 5th day blastocyst transplant,SET5)亚组、第6日单囊胚移植(single 6th day blastocyst transplant,SET6)亚组、第3日双卵裂期胚胎移植(double cleavage stage embryo transplant,DET3)亚组、第5日双囊胚移植(double 5th day blastocyst transplant,DET5)亚组、第6日双囊胚移植(double 6th day blastocyst transplant,DET6)亚组。所有患者均随访至2020年6月30日,比较同一年龄组内各亚组的临床结局。结果①≤30周岁组:SET5亚组临床妊娠率、持续妊娠率及活产率分别为66.17%(221/334)、60.48%(202/334)及35.93%(120/334),分别高于SET3亚组[41.18%(28/68)、36.76%(25/68)、25.00%(17/68),P<0.001、P=0.001、P=0.045]及SET6亚组[54.42%(80/147)、43.54%(64/147)、27.21%(40/147),P<0.001、P=0.001、P<0.001];DET5亚组多胎率[47.80%(76/159)]高于DET6亚组[29.49%(23/78)](P=0.007)。②30~35周岁组:SET5亚组临床妊娠率、持续妊娠率及活产率分别为63.59%(138/217)、55.30%(120/217)及29.95%(65/217),分别高于SET3亚组[30.65%(19/62)、27.42%(17/62)、14.52%(9/62),P<0.001、P<0.001、P=0.015];DET5亚组多胎率[56.86%(58/102)]高于DET3亚组[32.54%(41/126)]及DET6亚组[28.57%(16/56)],差异均有统计学意义(P<0.001及P=0.001)。③35周岁以上组:SET5亚组临床妊娠率、持续妊娠率及活产率[53.45%(31/58)、39.66%(23/58)、20.69%(12/58)]与SET6亚组[43.75%(21/48)、35.42%(17/48)、16.76%(8/48)]比较,差异均无统计学意义(P=0.320、P=0.655、P=0.58Objective To explore how to make transplantation strategy for patients of different ages in frozen-thawed embryo(FET)cycle.Methods A retrospective cohort analysis of the first FET cycles during the period from January 2018 to April 2020 in Reproductive Center of Ningbo Women&Children Hospital was performed.Based on the age of the patients,they were divided into three groups:≤30 years old group(1150 cycles),30-35 years old group(932 cycles)and>35 years old group(405 cycles).In each age group,according to the grade and number of transferred embryos,they were divided into the single cleavage stage embryo transplant(SET3)subgroup,the single 5th day blastocyst transplant(SET5)subgroup,the single 6th day blastocyst transplant(SET6)subgroup,the double cleavage stage embryos transplant(DET3)subgroup,the double 5th day blastocyst transplant(DET5)subgroup and the double 6th day blastocyst transplant(DET6)subgroup.All patients were followed up until June 30,2020.The clinical outcomes of each subgroups within the same age group were compared.Results 1)In≤30 years old group:the clinical pregnancy rate,the persistent pregnancy rate and the live birth rate in SET5 subgroup were 66.17%(221/334),60.48%(202/334),35.93%(120/334),respectively,which were higher than those in SET3 subgroup[41.18%(28/68),36.76%(25/68),25.00%(17/68);P<0.001,P=0.001,P=0.045]and that in SET6 subgroup[54.42%(80/147),43.54%(64/147),27.21%(40/147);P<0.001,P=0.001,P<0.001].The multiple rate in DET5 subgroup was 47.80%(76/159),which was higher than that in DET6 subgroup[29.49%(23/78),P=0.007].2)In 30-35 years old group:the clinical pregnancy rate,the persistent pregnancy rate and the live birth rate in SET5 subgroup were 63.59%(138/217),55.30%(120/217)and 29.95%(65/217),which were higher than those in SET3 subgroup[30.65%(19/62),27.42%(17/62),14.52%(9/62);P<0.001,P<0.001,P=0.015].The multiple rate in DET5 subgroup was 56.86%(58/102),which was higher than that in DET3 subgroup[32.54%(41/126)]and DET6 subgroup[28.57%(16/56)],and the differences were statisti

关 键 词：年龄 冷冻 胚胎移植 妊娠率 多胎 

分 类 号：R714.8[医药卫生—妇产科学]