冻融移植周期囊胚自发性皱缩对妊娠结局和新生儿结局的影响  

Effect of Spontaneous Blastocyst Collapse on Pregnancy and Neonatal Outcomes in Frozen-thawed Transfer Cycle

作　　者：李丹[1] 余琼 刘群[1] 任新玲 靳镭 Li Dan;Yu Qiong;Liu Qun(Reproductive Medicine Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院生殖医学中心,武汉430030

出　　处：《华中科技大学学报（医学版）》2023年第6期834-838,共5页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：国家自然科学基金资助项目(No.81701509)。

摘　　要：目的观察冻融移植周期中囊胚自发性皱缩对妊娠结局及新生儿结局的影响。方法回顾性分析2018年1月至2020年12月共10120个单囊胚冻融移植周期的临床资料,其中133个周期移植胚胎为自发性皱缩囊胚(皱缩组),通过1∶1倾向性评分匹配(PSM)均衡组间协变量后获取133个周期移植胚胎为未皱缩囊胚(未皱缩组),比较两组的妊娠结局和新生儿结局。结果皱缩组活产率明显低于未皱缩组(30.08%vs.45.86%,P<0.01),皱缩组着床率、临床妊娠率降低,早期流产率升高,但差异均无统计学意义(均P>0.05)。Logistic回归分析结果显示,女方年龄、不孕类型、囊胚是否发生自发性皱缩对活产有显著影响(均P<0.05),囊胚皱缩组与未皱缩组的活产优势比(OR)为0.54(95%CI:0.32~0.91)。两组新生儿结局比较,出生时妊娠天数、出生体重、男性新生儿比例差异均无统计学意义(均P>0.05)。两组活产新生儿中各有2例早产,皱缩组单胎妊娠新生儿有1例出生缺陷,为婴儿肾上腺增大;未皱缩组单胎妊娠新生儿无出生缺陷。结论在冻融移植周期中,移植自发性皱缩囊胚会降低母体活产率,但移植自发性皱缩囊胚并不会增加围生期不良结局和新生儿缺陷的发生率,可以将囊胚是否出现自发性皱缩作为改进胚胎选择的手段,以提高活产率改善辅助生殖技术妊娠结局。Objective To observe the effect of spontaneous blastocyst collapse on pregnancy and neonatal outcomes in frozen-thawed transfer cycle.Methods The clinical data of 10120 single blastocyst frozen-thawed transfer cycles from January 2018 to December 2020 was retrospectively analyzed,of which 133 cycles were spontaneous collapsed blastocysts(collapse group),133 cycles of transplanted embryos were obtained as non-collapse blastocysts(non-collapse group)after balancing the covariates between groups by 1∶1 propensity score matching(PSM),pregnancy and neonatal outcomes were compared between the two groups.Results The live birth rate in collapse group was significantly lower than that in non-collapse group(30.08%vs.45.86%,P<0.01).The implantation rate and clinical pregnancy rate in collapse group were decreased,and the early abortion rate was increased,but the differences were not statistically significant(all P>0.05).Logistic regression analysis showed that women's age,infertility type and spontaneous blastocyst collapse had significant effects on live birth(all P<0.05).The odds ratio of live birth between collapse group and non-collapse group was 0.54(95%CI:0.32~0.91).There was no statistically significant difference in the gestation days at birth,birth weight and the proportion of male newborns between the two groups(all P>0.05).There were 2 premature births in live birth of each group,and 1 birth defect in singleton pregnancy in collapse group,which was the enlargement of infant adrenal gland.There was no birth defect in singleton pregnancy newborns in non-collapse group.Conclusion In frozen-thawed transfer cycle,the transplantation of spontaneous collapsed blastocysts can reduce the maternal live birth rate,spontaneous collapsed blastocysts for implantation may not increase incidence rates of poor perinatal outcomes and neonatal defects.Spontaneous collapsed blastocysts can be used as a means to improve embryo selection,so as to improve the live birth rate and improve the pregnancy outcome of assisted reproductive

关 键 词：冻融移植周期 单囊胚移植 自发性皱缩 妊娠结局 新生儿结局 

分 类 号：R715.2[医药卫生—妇产科学]