体外受精获得全部非优质胚胎周期的移植策略分析

Analysis of low-quality embryo transfer strategy in in vitro fertilization and embryo transfer cycle

目的探讨体外受精获得全部非优质胚胎周期的移植策略。方法回顾性分析浙江大学医学院附属邵逸夫医院1998年12月至2010年6月全部胚胎为非优质胚胎的促排周期资料共621个周期，其中新鲜胚胎移植574个周期、冻融胚胎移植作为体外受精后首次胚胎移植47个周期，应用多因素Logisdc回归方法分析l临床相关因素与临床妊娠率之间的关系。结果冻融胚胎移植作为体外受精后首次胚胎移植组的临床妊娠率显著高于新鲜胚胎移植组[38．3％（18／47）比22．1％（127／574），P〈0．05]；年龄和移植时机与临床妊娠率密切相关，年龄因素校正后仍显示冻融胚胎移植作为体外受精后首次胚胎移植的临床妊娠率高于新鲜胚胎移植组（OR：2．107，95％CI：1．128—3．939，P〈0．05）。结论冻融胚胎移植作为体外受精后获得全部非优质胚胎周期的首次胚胎移植，可以获得较新鲜胚胎移植更高的临床妊娠率。

Objective To investigate the transfer strategy of low-quality embryo in in vitro fertilization and embryo transfer （IVF-ET） cycle. Methods A retrospective analysis was performed for the clinical data of 621 IVF-ET cycles under controlled ovarian hyperstimulation, including 574 fresh embryo transfer （ET） cycles （Group T1 ） and 47 frozen-thawed embryo transfer （FET） as the first ET cycles （Group C1 ）. Logistic regression was used to model the probability of clinical pregnancy rate based on the cycle-specific factors. Results The clinical pregnancy rate was significantly higher in Group C1 than Group T1 [ 38. 3 % （ 18/47 ） vs 22. 1% （ 127/574 ）, P 〈 0.05 ]. Multivariate logistic regression analysis revealed that patient age and ET method were significantly associated with the clinical pregnancy rate. After adjusting for patient age, the clinical pregnancy rate remained significantly higher in Group CI than Group T1 （OR： 2. 107, 95% CI： 1. 128 -3.939, P 〈0. 05）. Conclusion The use of FET instead of fresh ET may improve the clinical pregnancy rate in low-quality embryo cycles.