冻胚移植发生复合妊娠的影响因素分析  

Analysis of Factors Influencing the Occurrence of Heterotopic Pregnancy After Frozen Embryo Transfer

作　　者：庹平 李阳 刘杰 赵小玲 熊奕雯 解迪 张娟 TUO Ping;LI Yang;LIU Jie;ZHAO Xiaoling;XIONG Yiwven;XIE Di;ZHANG Juan(Department of Reproductive Medicine,General Hospital of Central Theater Command,Wuhan Hubei 430070,China)

机构地区：[1]中部战区总医院生殖医学科,湖北武汉430070

出　　处：《联勤军事医学》2024年第4期293-296,346,共5页Military Medicine of Joint Logistics

基　　金：湖北省中医药科研立项项目(ZY2023F051)。

摘　　要：目的 探讨影响冻胚移植(frozen embryo transfer, FET)发生复合妊娠(heterotopic pregnancy, HP)的相关性因素。方法 回顾性分析2016-01/2022-06月在作者医院生殖医学科行FET术后妊娠178例患者的临床资料,根据妊娠部位分为HP组(n=17)、异位妊娠组(n=76)、宫内妊娠组(n=85)。结果 3组患者因输卵管因素造成不孕的比例比较差异有统计学意义(P<0.05),异位妊娠组患者因输卵管因素造成不孕的比例高于宫内妊娠组(P<0.05)。HP组和异位妊娠组既往有输卵管手术史的患者占比明显高于宫内妊娠组(P<0.05)。3组FET患者移植胚胎个数差异有统计学意义(P<0.05),异位妊娠组中单胚胎移植率明显低于宫内妊娠组(P<0.05)。HP组和FET异位妊娠组患者卵裂期胚胎移植率明显高于宫内妊娠组,囊胚移植率明显低于宫内妊娠组(P均<0.05)。进一步Logistic回归分析发现,相对于FET宫内妊娠,输卵管手术史会增加FET发生HP的风险(OR=5.250,95%CI:1.467~18.788),移植胚胎个数的增多会增加FET发生HP的风险(OR=14.336,95%CI:1.381~148.849),而移植囊胚会降低FET发生HP的风险(OR=0.164,95%CI:0.027~0.996)。结论 输卵管手术史是FET发生HP的高危因素,而通过减少移植胚胎个数和囊胚移植可降低HP的发生率。Objective To investigate the correlation factors of heterotopic pregnancy(HP) after frozen embryo transfer(FET).Methods Clinical data of patients with pregnancy after FET in the reproductive medicine department of the author′s hospital from January 2016 to June 2022 were retrospectivly analyzed, the patients were divided into HP group(n=17), ectopic pregnancy group(n=76) and intrauterine pregnancy group(n=85) according to the location of pregnancy.Results There was a statistically significant difference in the proportion of infertility caused by tubal factors among the three groups(P<0.05), and the proportion of infertility caused by tubal factors in the ectopic pregnancy group was higher than that in the intrauterine pregnancy group(P<0.05). The proportion of patients with previous tubal surgery in HP and ectopic pregnancy groups was significantly higher than that in intrauterine pregnancy group(P<0.05). There was a significant difference in the number of transferred embryos in FET patients among the three groups(P<0.05), the single embryo transfer rate in ectopic pregnancy group was significantly lower than that in intrauterine pregnancy group(P<0.05). The cleavage embryo transfer rates of patients in HP and FET ectopic pregnancy groups were significantly higher than that of intrauterine pregnancy group, and the blastocyst transfer rates were significantly lower than that of intrauterine pregnancy group(all P<0.05). Further Logistic regression analysis showed that compared with FET intrauterine pregnancy, the history of tubal surgery increased risks of FET occured HP(OR=5.250, 95%CI:1.467-18.788), the increased number of embryos transferred was associated with a higher risks of FET occured HP(OR=14.336, 95%CI: 1.381-148.849), while blastocysts transfer would reduce the risk of FET occured HP(OR=0.164, 95%CI: 0.027-0.996).Conclusion The history of tubal surgery is a risk factor for HP after FET, and the incidence of HP can be diminished by reducing the number of embryos transferred and blastocyst transfer.

关 键 词：冻胚移植 复合妊娠 异位妊娠 输卵管手术史 囊胚移植 

分 类 号：R714[医药卫生—妇产科学]