冻融卵裂期胚胎与囊胚移植的妊娠结局及第二性别比的比较  

Comparison of pregnancy outcomes and secondary sex ratio between frozen-thawed embryo transfer at cleavage stage and blastocyst stage

作　　者：余柯达[1] 毛佳婷 包云 柴娟[1] 高辉[1] 师帅[1] YU Keda;MAO Jiating;BAO Yun;CHAI Juan;GAO Hui;SHI Shuai(Center of Reproductive Medicine,Jinhua People's Hospital,Jinhua 321000,China)

机构地区：[1]金华市人民医院生殖医学中心,321000

出　　处：《浙江医学》2023年第12期1274-1278,共5页Zhejiang Medical Journal

基　　金：浙江省卫生健康科技计划项目(2022KY1333);金华市科学技术研究计划项目(2020-3-053)。

摘　　要：目的探讨冻融周期中卵裂期胚胎与囊胚移植对妊娠结局及第二性别比(SSR)的影响。方法选取2019年6月至2021年3月在金华市人民医院生殖医学中心行冻融胚胎移植的977个周期。根据移植胚胎的发育阶段分为第3天卵裂期胚胎组(D3组,699个周期)和第5天囊胚组(D5组,278个周期)。对两组的临床妊娠率、胚胎种植率、流产率和多胎妊娠率等妊娠结局及出生体重、早产率和SSR等新生儿指标进行比较。筛选临床认为与妊娠结局有关及单因素分析P<0.15的变量行多因素logistic回归分析,筛选与冻融周期胚胎移植妊娠结局相关的独立影响因素。结果D5组移植胚胎数少于D3组,生化妊娠率、临床妊娠率、胚胎种植率、总活产率、单胎活产率和SSR均高于D3组,差异均有统计学意义(均P<0.05)。两组多胎妊娠率、异位妊娠率、流产率、早产率、孕周和出生体重等比较差异均无统计学意义(均P>0.05)。多因素logistic回归分析提示,年龄>30岁(OR=0.747,P<0.05)、移植胚胎数(OR=2.271,P<0.01)和囊胚移植(OR=1.843,P<0.01)是冻融周期临床妊娠的独立影响因素,囊胚移植是出生男婴的独立影响因素(OR=1.436,P<0.05)。结论冻融周期中囊胚移植在降低移植胚胎数的同时,可以提升胚胎种植率和临床妊娠率,因此,建议辅助生殖技术周期中早期胚胎培养至囊胚后再行移植或冷冻,但其可能会提高SSR,对造成SSR偏移的具体因素尚需进一步研究。Objective To compared the pregnancy outcomes and second sex ratio(SSR)between frozen-thawed embryo transfer at cleavage stage and blastocyst stage.Methods A total of 977 cycles of frozen-thawed embryo transfer in the Center of Reproductive Medicine in Jinhua People's Hospital from June 2019 to March 2021 were included in the study.According to the developmental stage of the transplanted embryo,the cycles were divided into cleavage embryo group(group D3,n=699)and blastocyst group(group D5,n=278).The pregnancy outcomes such as clinical pregnancy rate,embryo implantation rate,abortion rate,multiple pregnancy rates;and neonatal indicators such as birth weight,preterm birth rate and SSR were compared.The variables clinically considered to be related to pregnancy outcome and P<0.15 from univariate analysis were screened for multivariate logistic regression analysis to find the influencing factors of pregnancy outcome of frozen-thawed embryo transfer.Results The number of transferred embryos in the D5 group was less than that in the D3 group,and the biochemical pregnancy rate,clinical pregnancy rate,embryo implantation rate,total live birth rate,single birth live birth rate and SSR were significantly higher than those in the D3 group(all P<0.05).There was no significant difference in multiple pregnancy rate,ectopic pregnancy rate,abortion rate,preterm birth rate,gestational weeks,and birth weight between the two groups(all P>0.05).Multivariate logistic regression analysis showed that age>30(OR=0.747,P<0.05),number of embryos transferred(OR=2.271,P<0.01)and blastocyst transfer(OR=1.843,P<0.01)were independent influencing factors for clinical pregnancy of frozen-thawed embryo transfer,and blastocyst transfer was independent influencing factors for male birth(OR=1.436,P<0.05).Conclusion Blastocyst transfer in the frozen-thawed cycle can not only reduce the number of transferred embryos,but also improve the embryo implantation rate and clinical pregnancy rate.Therefore,this study suggests that early embryos in the assisted

关 键 词：囊胚移植 卵裂期胚胎移植 妊娠结局 第二性别比 

分 类 号：R714.8[医药卫生—妇产科学]