玻璃化冷冻囊胚复苏移植与新鲜囊胚移植的临床结局比较

Comparison of clinical outcomes between vitrified-thawed blastocyst transfer and fresh blastocyst transfer

目的：比较新鲜囊胚移植周期与玻璃化冷冻囊胚复苏移植周期的临床结局。方法：回顾性分析2009~2011年本院生殖中心完成的874例囊胚移植周期,其中新鲜囊胚移植周期（A组）280例,冻融囊胚复苏移植周期（B组）594例,比较两组临床妊娠率。种植率。妊娠结局及新生儿情况等各项指标。结果：①A组平均移植胚胎数显著高于B组,分别为（1.88 ± 0.47）和（1.70 ± 0.53）个;临床妊娠率及种植率A组（43.93%。24.96%）显著低于B组（55.39%。40.51%,P 〈 0.05）;②A组和B组的流产率。早产率。单胎率。多胎率分别为13.82%。32.46%。70.16%。29.84%和16.72%。33.84%。71.86%。28.14%,孕龄分别为（265.49 ± 14.45）d。（264.43 ± 16.08）d均无统计学差异（P 〉 0.05）。两组中仅B组见1例异位妊娠,而A组无异位妊娠;③A组和B组巨大儿。生长受限及新生儿出生缺陷发生率分别为6.00%。19.66%。1.70%和9.40%。17.82%。0.90%,两组间无统计学差异。结论：玻璃化冷冻囊胚复苏移植显著提高了囊胚移植的种植率及妊娠率,且并没有增加新生儿出生缺陷。流产率。早产率,也没有增加巨大儿和新生儿生长受限的出生比率。因此,玻璃化冻融囊胚移植技术是安全有效的,值得在临床上应用推广。

Objective：To compare the clinical outcomes between fresh blastocyst transfer with vitrified-thawed blastocyst transfer. Methods：From 2009 to 2011,874 cases of blastocyst transfer cycles were performed in our center,including 280 cases of fresh blastocyst transfer （group A）,and 594 cases of vitrified-thawed blastocyst transfer （group B）. Meanwhile a retrospective analysis was performed on the two groups by comparing clinical pregnancy rate,implantation rate,pregnancy outcomes and neonatal status. Results：①The number of transferred embryos in group A（1.88 ± 0.47） was higher than that of group B（1.70 ± 0.53）,and the clinical pregnancy rate and implantation rate of group A was significantly lower than that of group B（43.93%,24.96% and 55.39%,40.51%,respectively,P 〈 0.05）. ②No statistical differences were found in the rate of abortion,premature delivery rate,gestational age,pregnancy rate and multiple pregnancy rate in group A（13.82%,32.46%,265.49 ± 14.45d,70.16%,29.84%,respectively） and group B（16.72%,33.84%,264.43 ± 16.08 d,71.86%,28.14%,respectively）. In group B,there was only one case of ectopic pregnancy,while no ectopic pregnancy in group A. ③There were no statistical differences in macrosomia,growth restriction and the rate of birth defect between group A（6%,19.66%,1.7%,respectively）and group B（9.4%,17.82%,0.9%,respectively）. Conclusion：Vitrified-thawed blastocysts transplantation significantly improved blastocyst implantation rate and pregnancy rate,and did not increase neonatal birth defects,miscarriage,premature delivery rate,and there was no increase of macrosomia and neonatal growth restriction ratio at birth. Therefore,vitrified-thawed blastocysts transfer is an effective and safe protocol in ART practice.