IVF/ICSI首次移植妊娠结局对下次冻融胚胎移植妊娠结局的影响  

Effect of pregnancy outcome of the first IVF/ICSI embryo transfer cycle on the next frozen-thawed embryo transfer cycle

作　　者：徐琪起 胡凯伦 陈盼盼 张纯茜 赵炜[1] 朱依敏[1] 张润驹[1] 邢兰凤[1] 张丹[1] Xu Qiqi;Hu Kailun;Chen Panpan;Zhang Chunxi;Zhao Wei;Zhu Yimin;Zhang Runju;Xing Lanfeng;Zhang Dan(Department of Reproductive Endocrinology,Women's Hospital of Zhejiang University,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属妇产科医院生殖内分泌科,杭州310006

出　　处：《中华生殖与避孕杂志》2022年第12期1226-1233,共8页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)首次移植周期妊娠结局对下次冻融胚胎移植妊娠结局的影响。方法回顾性队列研究分析浙江大学医学院附属妇产科医院生殖内分泌科于2010年1月至2019年12月期间接受IVF/ICSI助孕的6658例不孕患者的临床资料。根据第一次移植周期为新鲜胚胎移植或冷冻胚胎移植分为鲜胚-冻胚组(n=4310)和冻胚-冻胚组(n=2348)。再根据首次移植周期的妊娠结局各分为4个亚组,即未妊娠亚组、生化妊娠亚组、妊娠丢失亚组和活产亚组。比较各组间第二次移植周期活产率是否存在差异。结果在鲜胚-冻胚组中,4个亚组患者的第二次移植活产率分别为31.3%(972/3109)、33.7%(92/273)、33.3%(169/507)、39.2%(165/421);与未妊娠亚组比较,活产亚组活产率差异有统计学意义[经校正后,aP<0.001,aOR(95%CI)=1.555(1.245~1.942)]。在冻胚-冻胚组中,4个亚组患者的第二次移植活产率分别为37.3%(655/1754)、47.0%(79/168)、45.4%(122/269)、44.6%(70/157);与未妊娠亚组比较,生化妊娠亚组、妊娠丢失亚组、活产亚组活产率差异有统计学意义[经校正后,aP=0.018,aOR(95%CI)=1.471(1.069~2.026);aP=0.014,aOR(95%CI)=1.388(1.069~1.802);aP=0.035,aOR(95%CI)=1.452(1.026~2.054)]。结论在鲜胚-冻胚组中,首次移植周期取得活产,随后周期的活产率显著增加;而在冻胚-冻胚组中,首次移植周期的妊娠结局为生化妊娠、妊娠丢失或活产,随后周期的活产率显著增加。Objective To explore the effect of pregnancy outcome of the first in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)and embryo transfer cycle on the next frozen-thawed embryo transfer cycle.Methods A retrospective cohort study was designed by collecting data from 6658 infertile patients in Department of Reproductive Endocrinology,Women's Hospital of Zhejiang University from January 2010 to December 2019.Two groups were included,the fresh embryo-frozen embryo group(n=4310)and the frozen embryo-frozen embryo group(n=2348),and each group was divided into four subgroups according to the pregnancy outcome of the first transfer cycle:non-pregnancy subgroup,biochemical pregnancy subgroup,pregnancy loss subgroup,and live birth subgroup.In each group,the live birth rate(LBR)of the second transfer cycle was compared among the four subgroups.Results In the second transfer cycle of the fresh embryo-frozen embryo group,LBR in each subgroup was 31.3%(972/3109),33.7%(92/273),33.3%(169/507),and 39.2%(165/421),respectively.Compared with non-pregnancy subgroup,the difference of LBR in the live birth subgroup was statistically significant[after adjustment,aP<0.001,aOR(95%CI)=1.555(1.245-1.942)].In the second transfer cycle of the frozen embryo-frozen embryo group,LBR in each subgroup was 37.3%(655/1754),47.0%(79/168),45.4%(122/269),and 44.6%(70/157),respectively.Compared with non-pregnancy subgroup,the differences of LBR in biochemical pregnancy subgroup,pregnancy loss subgroup and live birth subgroup were statistically significant[after adjustment,aP=0.018,aOR(95%CI)=1.471(1.069-2.026);aP=0.014,aOR(95%CI)=1.388(1.069-1.802);aP=0.035,aOR(95%CI)=1.452(1.026-2.054)].Conclusion In the fresh embryo-frozen embryo group,live birth in the first transfer cycle is associated with increased LBR in the subsequent cycles,while in the frozen embryo-frozen embryo group,biochemical pregnancy,pregnancy loss,or live birth in the first transfer cycle are associated with increased LBR in the following cycles.

关 键 词：不孕 冻融胚胎移植 妊娠结局 活产 

分 类 号：R714.8[医药卫生—妇产科学]