冻融优质单囊胚移植失败后重复周期胚胎移植策略的探讨  

Effects of different embryo transfer strategies on pregnancy outcomes in patients following repeated frozen-thawed high-quality single blastocyst transfer

作　　者：李苏萍[1] 刘海鹏[1] 彭姝明[1] 杨帆[1] 段丽[1] LI Su-ping;LIU Hai-peng;PENG Shu-ming;YANG Fan;DUAN Li(Reproductive Medicine Center,Chenzhou First People’s Hospital,Chenzhou423000)

机构地区：[1]湖南省郴州市第一人民医院生殖医学中心,郴州423000

出　　处：《生殖医学杂志》2024年第9期1147-1152,共6页Journal of Reproductive Medicine

摘　　要：目的探讨冻融优质单囊胚移植失败后重复周期的胚胎移植策略。方法回顾性分析2018年7月至2022年10月在我中心进行冻融优质单囊胚移植后重复周期治疗患者的临床资料,共887个周期。根据患者年龄不同分为<35岁组(568个周期)和≥35岁组(319个周期),每组又根据胚胎移植情况分为5个亚组:单优囊组(移植冻融优质单囊胚)、双优囊组(移植冻融优质双囊胚)、优+非优囊组(移植冻融优质+非优质双囊胚)、双非优囊组(移植冻融非优质双囊胚)及双优卵裂组(移植冻融双卵裂胚)。比较各组患者的基础资料及妊娠结局。结果<35岁组中单优囊组、双优囊组、优+非优囊组、双非优囊组及双优卵裂组患者的年龄、基础FSH、移植日内膜厚度等基础资料比较均无显著性差异(P>0.05);单优囊组的临床妊娠率显著低于其他4组(60.41%vs.77.08%、72.73%、69.74%、70.83%,P<0.05),活产率亦显著低于其他4组(49.80%vs.68.75%、61.82%、59.21%、61.11%,P<0.05),双优卵裂组的多胎妊娠率显著高于单优囊组(38.24%vs.1.35%,P<0.05),但显著低于双优囊组(67.57%)、优+非优囊组(57.50%)及双非优囊组(56.60%)(P<0.05)。≥35岁组中各亚组的基础资料亦无显著性差异(P>0.05);各亚组间的临床妊娠率、活产率、流产率比较均无显著性差异(P>0.05),但单优囊组的多胎妊娠率显著低于其他4组(0.00%vs.33.33%、29.17%、20.59%、15.00%,P<0.05)。结论对于接受冻融优质单囊胚移植后行重复周期治疗的不孕患者,冻融胚胎移植策略的选择需要综合权衡。年龄≥35岁的患者,5种胚胎移植策略获得的临床结局相近,可以根据患者实际情况进行选择;而年龄<35岁的患者,在没有条件进行冻融优质单囊胚移植时,也可以考虑冻融优质双卵裂胚移植策略,但其后续多胎妊娠率风险较高,仍需要关注。Objective:To explore the effect of different embryo transfer strategies on the outcome of pregnancy following repeated frozen-thawed high-quality single blastocyst transfer.Methods:A retrospective study was conducted on women undergoing repeated frozen-thawed high-quality single blastocyst transfer in Reproductive Medicine Center of Chenzhou First People’s Hospital from July 2018 to October 2022.A total of 887 patients were included in the study and divided into two groups as groupⅠ(age<35,n=568)and groupⅡ(age≥35,n=319).Moreover based on the embryo transfer strategy,patients were divided into group A(one high-quality blastocyst transfer group,n=79),group B(two high-quality blastocyst transfer group,n=79),group C(one high-quality blastocyst+one poor-quality blastocyst transfer group,n=117),group D(double poor-quality blastocyst transfer group,n=141)and group E(double high-quality cleavage transfer group,n=226).The basic clinical characteristics and pregnancy outcomes among the five groups were compared respectively.Results:In groupⅠ,there were no significant differences in the age,basal FSH level,endometrial thickness on the transfer day among the five groups(P>0.05),the clinical pregnancy rate(60.41%vs.77.08%,72.73%,69.74%,70.83%,P<0.05)and live birth rate(49.80%vs.68.75%,61.82%,59.21%,61.11%,P<0.05)in group A were significantly lower than those of other groups(P<0.05),the multiple pregnancy rate in group E was significantly higher than that in group A(38.24%vs.1.35%,P<0.05)while significantly lower than those in group B(67.57%,P<0.05),group C(57.50%,P<0.05)and group D(56.60%,P<0.05).In groupⅡ,there were no significant differences in the basic clinical characteristics,the clinical pregnancy rate and live birth rate among the five groups(P>0.05),while the multiple pregnancy rate in group A was significantly lower than those of other four groups(0.00%vs.33.33%,29.17%,20.59%,15.00%,P<0.05).Conclusions:For patients undergoing repeated frozen-thawed high-quality single blastocyst transfer,the choice of fro

关 键 词：冻融胚胎移植 单囊胚移植 重复周期 胚胎移植策略 

分 类 号：R711.6[医药卫生—妇产科学]