两种不同子宫内膜准备方案对FET周期单胎子代围产期结局的影响

Effects of two different endometrial preparation protocols on singleton perinatal outcomes of frozen-thawed embryo transfer cycles

目的探讨冻融胚胎移植(FET)周期中两种不同子宫内膜准备方案对单胎子代围产期结局的影响。方法回顾性分析2017年1月至2018年12月在空军军医大学唐都医院生殖医学中心通过FET获得单胎活产儿的976个周期。根据不同的子宫内膜准备方案,分为两组:自然周期(NC)组(n=544);激素替代周期(HRT)组(n=432)。收集患者一般资料,包括女方年龄、男方年龄、体重指数(BMI)、抗苗勒管激素(AMH)水平、不孕类型、不孕因素、不孕年限、多囊卵巢综合征(PCOS)患者占比、移植日子宫内膜厚度及形态、移植胚胎数、移植次数、移植胚胎胎龄、辅助孵化(AH);比较两组的巨大儿发生率、低体重儿发生率、早产率、出生性别比、剖宫产率、平均出生孕周、平均出生体重及平均出生身长的差异。结果两种方案一般资料中,HRT组AMH水平[(4.51±3.62)ng/ml vs.(3.51±2.10)ng/ml]、PCOS患者占比(19.91%vs.5.33%)、移植胚胎数[(1.65±0.52)vs.(1.57±0.51)]及移植卵裂期胚胎占比(56.02%vs.53.68%)均显著高于NC组(P<0.05)。围产期结局中,HRT组剖宫产率(77.78%vs.70.77%)、巨大儿发生率(8.10%vs.4.96%)及早产率(7.41%vs.5.88%)均显著高于NC组(P<0.05);而两组间低体重儿发生率、出生性别比、平均出生孕周、平均出生体重及平均出生身长等方面均无显著性差异(P>0.05)。通过多元回归模型校正混杂因素后,两组间早产率无显著性差异(P>0.05),而HRT组巨大儿发生率[OR=1.42,95%CI(1.12,2.05)]及剖宫产率[OR=1.30,95%CI(1.23,1.56)]仍显著高于NC组(P<0.05)。结论相较于HRT方案,NC方案的FET患者单胎子代巨大儿发生率及剖宫产率更低,围产期结局更好。

Objective:To explore the two different endometrial preparation protocols on singleton perinatal outcomes of frozen-thawed embryo transfer(FET)cycles.Methods:The data of 976 FET cycle with single live birth was analyzed in our reproductive center between January 2017 to December 2018 were analyzed.According to different endometrial preparation protocols,the cycles were divided into two groups:natural cycles group(NC)(n=544)and hormone replacement therapy cycles group(HRT)(n=432).The patients’general information including female&male age,body mass index(BMI),anti-Müllerian hormone(AMH)level,type,cause&duration of infertility,proportion of patients with polycystic ovary syndrome(PCOS),endometrial thickness and morphology on transfer day,number of embryos transferred,times of transplantation,days of embryos transferred,and assisted hatching(AH)were collected.The incidence of macrosomia,low birth weight rate,premature birth rate,sex ratio at birth,cesarean section rate,average gestational age,average birth weight&length were compared between the two groups.Results:In general data of the two groups,the level of AMH[(4.51±3.62)ng/ml vs.(3.51±2.10)ng/ml],the proportion of patients with PCOS(19.91%vs.5.33%),the number of embryos transferred[(1.65±0.52)vs.(1.57±0.51)],and the rate of cleavage embryos transferred(56.02%vs.53.68%)in HRT group were significantly higher than those in NC group(all P<0.05).In perinatal outcomes,the cesarean section rate(77.78%vs.70.77%),macrosomia rate(8.10%vs.4.96%)and preterm birth rate(7.41%vs.5.88%)in HRT group were also significantly higher than those in NC group(all P<0.05).There was no significant difference in the incidence of low birth weight,sex ratio at birth,average gestational weeks,average birth weight and length between the two groups(P>0.05).After adjusting for confounding factors by multiple regression model,there was no significant difference in preterm birth rate between the two groups(P>0.05),while the macrosomia rate[OR=1.42,95%CI(1.12,2.05)]and cesarean section rate[OR=1.30,95%CI(1.23,1.56)]in HRT group were still significantly higher than those in NC group(P<0.05).Conclusions:Nature cycle protocol of endometrial preparation has lower incidence of macrosomia in single offspring and cesarean section,and has better perinatal outcome following FET compared with HRT protocol.