冻融胚胎移植妊娠结局的影响因素分析

Affecting factors in outcome of frozen-thawed embryo transfer

目的探讨患者年龄、子宫内膜准备方案、移植胚胎数、胚胎的发育潜能和胚胎完整性对冻融胚胎移植（FET）妊娠结局的影响。方法选择2012年2月至2014年12月在海军总医院生殖中心接受FET治疗的1 346例患者,1 346个FET周期。按年龄〈30岁、30~〈35岁、35~〈40岁、≥40岁分为A、B、C、D四组;根据移植前不同子宫内膜准备方案分为：自然周期（N组）、人工周期（H组）和促排周期（S组）;根据移植胚胎数2、3枚分为E、F两组;根据解冻胚胎继续培养后卵裂球是否分裂生长,每个FET周期所移植胚胎中进一步卵裂的胚胎个数n,并据此分为I（n=0）,II（n=1）,III（n=2或3）三组;根据复苏后移植胚胎卵裂球的完整性分为两组：完整组和受损组。分别比较各组的妊娠结局。结果年龄方面,A组、B组、C组的妊娠率和着床率均高于D组,差异均具有统计学意义（P〈0.01）;自然周期、人工周期及促排周期3种子宫内膜准备方案,妊娠率和种植率三组间两两比较,差异无统计学意义（P〉0.05）;移植2枚或3枚胚胎,对妊娠结局（妊娠率45.56%vs.45.02%）影响不大（P〉0.05）,但两组着床率（26.07%vs.17.40%）有显著性差异（P〈0.05）;胚胎解冻后继续培养,随着进一步卵裂胚胎数目的增加,妊娠率（分别为25.27%、39.29%、52.37%）和着床率（分别为10.74%、19.79%、29.16%）均有逐渐升高的趋势,且三组的妊娠率和着床率两两比较,差异均具有统计学意义（P〈0.01）;胚胎完整组的妊娠率略高于胚胎受损组（45.08%vs.40.15%）,但无统计学差异（P〉0.05）,而相比较,胚胎完整组着床率显著高于胚胎受损组（24.65%vs.18.85%,P〈0.05）。结论移植前不同的子宫内膜准备方案对妊娠结局无显著影响;移植2枚或3枚胚胎对妊娠结局影响不大;年龄和卵裂球的完整性是影响FET成功的重要因素;冻融胚胎提前解冻并培养后,选择进一步卵裂的胚胎进行移植有助于提高妊娠率和着床率。

Objective： To investigate several possible influencing factors on success of frozen-thawed embryos transfer（FET）.Methods： A total of 1 346 cases of FET cycles were divided into series of groups based on different factors：Factor 1：age（≤29,30-34,35-39 and ≥40years groups,i.e.group A,B,C,D）;Factor 2：endometrial preparation protocols[natural cycle（group N）,artificial cycle（group H）and super ovulation cycle（group S）];Factor 3：transferred embryos number（2,3,i.e.group E,F）;Factor 4：number of merogenic embryos（0,1,≥2,i.e.group I,II,III）;Factor 5：integrity of the blastomeres of transfer embryo after thawed,intact group（all the transferred embryos with fully intact blastomeres）and damaged group（the transferred embryos with less than 50% damaged blastomeres）.Results：In the age groups,the average pregnancy rate（APR）and implantation rate（IR）of group A,B and C were all significant higher than those of group D（P〈0.01）.There were no significant differences in APR and IR among natural cycle（group N）,hormonally manipulated artificial programmed cycle（group H）and hormonally manipulate stimulated cycle（group S）（P 0.05）.There was no difference in pregnancy（45.56% vs.45.02%）when two embryos or three embryos were transferred,however,implantation rate of group E was significantly higher than group F（26.07% vs.17.40%）（P〈0.05）.Our results also indicated that the blastomere growth was a significant factor on success of transfer.The more the number of merogenic embryos was,the higher pregnancy rate（25.27%,39.29%and 52.37%,respectively）and implantation rate（10.74%,19.79% and 29.16%,respectively）were.The significant differences were found among group I,II and II（P〈0.01）.Furthermore,the damage embryos group had a slight lower pregnancy rate（40.15% vs.45.08%,P 0.05）and a significantly lower implantation rate（18.85% vs.24.65%,P〈0.05）compared with the intact embryos group.Conclusions： The transplantation endometrial preparation protocols have no significant effect on the success of frozen-thawed embryos.The numbers of transferred embryos have little effect on the outcome of pregnancy.Age and blastomere integrity are significant influencing factors on pregnancy outcome in FET cycles.Selection of the cryopreserved embryos with further cleavage after frozen-thawed increases pregnancy rate and implantation rate.