激光辅助孵化对冻融胚胎移植的临床结局及母婴安全性的影响  

Effects of laser-assisted hatching on clinical outcomes and maternal and fetal security in frozen-thawed embryo transfer

作　　者：杨宁[1] 唐淮云[1] 汤丽莎[1] Yang Ning;Tang Huaiyun;Tang Lisha(Center for Reproductive Medicine of Lianyungang Maternal and Child Health Care Hospital,Lianyungang 222000,China)

机构地区：[1]连云港市妇幼保健院生殖中心,连云港222000

出　　处：《中华生殖与避孕杂志》2022年第12期1250-1258,共9页Chinese Journal of Reproduction and Contraception

摘　　要：目的探讨在玻璃化冻融胚胎移植(frozen-thawed embryo transfer,FET)周期中,激光辅助孵化(laser-assisted hatching,LAH)对患者临床结局及母婴安全性的影响。方法采用回顾性队列研究分析连云港市妇幼保健院生殖中心自2017年1月至2020年1月期间玻璃化冷冻后行FET治疗的临床资料。共纳入641个FET周期,根据不同胚龄分为卵裂期移植周期和囊胚移植周期,不同胚龄周期根据复苏后是否行LAH分为LAH组和Non-LAH组(未行LAH)。采用单因素分析分别比较不同胚龄行LAH操作后患者临床妊娠结局和围产期母婴并发症的情况。采用多元logistic回归分析控制其他混杂因素,分析LAH对活产率的影响。主要观察指标为活产率。次要观察指标为临床妊娠率、种植率、多胎率、流产率、异位妊娠率、早产率、围产期母体相关并发症、新生儿结局。结果在卵裂期胚胎移植患者中,LAH组的临床结局与Non-LAH组相比差异均无统计学意义(均P>0.05);囊胚移植患者中,LAH组临床妊娠率[71.2%(109/153)]、种植率[61.2%(126/206)]、活产率[66.7%(102/153)]均高于Non-LAH组[56.2%(59/105),P=0.013;46.4%(65/140),P=0.007;48.6%(51/105),P=0.004],差异均有统计学意义,而在多胎率、流产率、异位妊娠率、早产率等方面两组相比,差异均无统计学意义(均P>0.05)。无论是卵裂期移植或是囊胚移植患者行LAH后,在围产期母体相关并发症、新生儿结局等方面与Non-LAH组差异均无统计学意义(均P>0.05)。经多元logistic回归分析校正混杂因素后,结果显示LAH对卵裂期胚胎FET患者的活产率无影响,但可提高囊胚FET患者的活产率(OR=2.656,95%CI=1.505~4.689,P=0.001)。结论在复苏移植周期中,LAH可以改善囊胚移植患者的临床结局,但无法改善卵裂期移植患者的临床结局;LAH对围产期母婴安全暂未显示有不良影响。Objective To investigate the effects of laser-assisted hatching(LAH)on clinical pregnancy outcomes and maternal and infant safety of frozen-thawed embryo transfer(FET).Methods A retrospective cohort study was conducted at Reproductive Center of Lianyungang Maternal and Child Health Care Hospital from January 2017 to January 2020.The clinical data of 641 FET cycles were analyzed,which were divided into the cleavage stage and blastocyst stage embryo transfer.The FET cycles of different embryo stages were divided into LAH group and Non-LAH group based on the method used with or with-out LAH.Clinical outcomes and maternal and infant information were compared using univariate analysis between LAH group and Non-LAH group.Multivariate logistic regression analysis was used to control other confounding factors and analyzed the effects of LAH on live birth rate.The primary outcome was live birth rate.Secondary outcomes included clinical pregnancy rate,implantation rate,multiple births rate,abortion rate,ectopic pregnancy rate,premature delivery rate,perinatal maternal complications and neonatal outcomes.Results The characteristics of patients were not significantly different between the two groups(P>0.05).In cleavage-stage embryo transfer group,there were no significant differences in clinical outcomes between LAH group and Non-LAH group(P>0.05).In the blastocyst embryo transfer patients,the clinical pregnancy rate[71.2%(109/153)],the implantation rate[61.2%(126/206)]and the live birth rate[66.7%(102/153)]in LAH group were significantly increased compared with the Non-LAH group[56.2%(59/105),P=0.013;46.4%(65/140),P=0.007;48.6%(51/105),P=0.004]and the rates of multiple pregnancy,abortion,ectopic pregnancy and preterm birth were similar between the two groups(all P>0.05).There were no statistical differences in perinatal maternal complications and neonatal outcomes between LAH group and Non-LAH group(all P>0.05).Multivariate logistic regression analysis showed that LAH had no effect on the live birth rate of FET patients at

关 键 词：囊胚 冻融胚胎移植 激光辅助孵化 卵裂期胚胎 临床结局 母婴安全 

分 类 号：R714.8[医药卫生—妇产科学]