因配偶重度少弱精子症不孕患者体外受精后移植新鲜胚胎与冷冻胚胎临床结局比较  

Clinical outcomes of fresh and frozen embryos transfer after in vitro fertilization in spouses of patients with severely low sperm concentration and motility

作　　者：胡晓晓 赵莉娟 蒋凌英[1,2] 张松英 HU Xiaoxiao;ZHAO Lijuan;JIANG Lingying;ZHANG Songying(Reproductive Medicine Center,Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,Hangzhou 310016,China;Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology,Hangzhou 310016,China)

机构地区：[1]浙江大学医学院附属邵逸夫医院生殖医学中心,浙江杭州310016 [2]浙江省妇产疾病临床医学研究中心,浙江杭州310016

出　　处：《浙江大学学报（医学版）》2024年第3期368-375,共8页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省临床医学研究中心专项(2022E50002)。

摘　　要：目的:评估因配偶重度少弱精子症不孕患者体外受精后移植新鲜胚胎(以下简称鲜胚移植)和冷冻胚胎(以下简称冻胚移植)的妊娠和新生儿结局,探讨该人群的最佳移植策略。方法:收集2018年4月至2022年4月在浙江大学医学院附属邵逸夫医院生殖医学中心因配偶重度少弱精子症不孕接受鲜胚和冻胚移植患者(n=2300)的临床资料,如年龄、抗米勒管激素水平、移植日内膜厚度、移植胚胎等。根据移植方式分为鲜胚移植组和冻胚移植组。经过倾向评分进行1∶1匹配后,鲜胚移植组和冻胚移植组各473例,评估两组的妊娠结局和新生儿结局。结果:鲜胚移植组和冻胚移植组的妊娠结局和新生儿结局总体上无明显差异(均P>0.05)。胚胎分层分析中,全优胚胎鲜胚移植组取卵数较非优胚胎鲜胚移植组明显增加(P<0.05),但极早期妊娠丢失率两组间相近(P>0.05);全优胚胎鲜胚移植组极早期妊娠丢失率明显高于全优胚胎冻胚移植组(P<0.05)。不同年龄组分层分析结果显示,20~<30岁鲜胚移植组取卵数和雌激素水平均明显高于30~<35岁组(均P<0.05),但临床妊娠率略低于30~<35岁组(P>0.05);20~<30岁鲜胚移植组的极早期妊娠丢失率较冻胚移植组明显增加(P<0.05)。结论:因配偶重度少弱精子症不孕患者进行鲜胚移植或冻胚移植后妊娠结局和新生儿结局总体上无明显差异。鲜胚移植可以缩短移植时间,避免胚胎冷冻损伤、降低费用,因此可以作为该类人群的首选移植方式。但如果母体雌激素水平过高,存在过度刺激倾向时,则不必刻意追求鲜胚移植。Objective:To compare the pregnancy and neonatal outcomes of in vitro fertilization-embryo transfer(IVF-ET)with fresh or frozen embryos in spouses of patients with severely low sperm concentration and motility.Methods:A total of 2300 patients whose spouses have severely low sperm concentration and motility underwent IVT-ET in the Reproduction Medicine Center,Sir Run Run Shaw Hospital from April 2018 to April 2022.After applying the propensity score matching(PSM),473 fresh embryo transferred cycles and 473 frozen embryo transferred cycles were selected for the study,and the pregnancy and neonatal outcomes were compared between the two groups.Results:There were no significant differences in pregnancy outcomes and neonatal outcomes between fresh and frozen embryo groups(all P>0.05).In the stratification analysis,the number of retrieved oocytes in the fresh good-quality embryo transfer group was significantly increased compared with the fresh poor-quality embryo group(P<0.05),but the very early pregnancy loss rates were similar between the two groups(P>0.05),while the rate in fresh good-quality embryo transfer group was significantly higher than that in the frozen good-quality embryo transfer group(P<0.05).Among different age groups of women,the number of retrieved oocytes and the level of estrogen in the fresh embryo transfer group was significantly higher in the 20 to<30 years old group than that in the 30 to<35 years old group(both P<0.05),but the clinical pregnancy rate was lower in the 20 to<30 years old group than that in the 30 to<35 years old group(P>0.05).Additionally,the very early pregnancy loss was significantly increased in the fresh embryo group compared with the frozen embryo group in the 20 to<30 years age group(P<0.05).Conclusions:There were no significant differences in pregnancy and neonatal outcomes between fresh and frozen embryo transfer in spouses of patients with severely low sperm concentration and motility undergoing IVF-ET.Due to the shorter transfer times,less embryo freezing damage and red

关 键 词：重度少弱精子 倾向评分匹配 新鲜胚胎移植 妊娠结局 新生儿结局 

分 类 号：R711.6[医药卫生—妇产科学]