复苏周期D5单囊胚移植与双囊胚移植对妊娠结局的影响

Impact of Day 5 single blastocyst transfer and double blastocysts transfer in frozen embryo transfer cycles on pregnancy outcome

目的探讨复苏周期第5天(D5)单囊胚移植与双囊胚移植对年龄<35岁、卵巢储备正常的不育症患者妊娠结局的影响。方法回顾性分析2013年1月至2015年4月我中心466例年龄<35岁、卵巢储备正常的不育症患者复苏周期D5囊胚移植的妊娠结局,根据D5囊胚移植个数分为D5单囊胚移植组(207例)与D5双囊胚移植组(259例),对两组的妊娠结局进行比较。结果两组的生化妊娠率、临床妊娠率、活产率、异位妊娠率、流产率及单卵双胎率比较均无显著性差异(P>0.05);双囊胚移植组的多胎妊娠率显著高于单囊胚移植组(52.6%vs.2.4%)(P<0.001);单囊胚移植组的种植率显著高于双囊胚移植组(79.2%vs.57.5%)(P<0.001);新生儿基本情况的统计显示,单囊胚移植组新生儿的胎龄及平均出生体重均显著大于双囊胚移植组[分别为(38.6±2.1)周vs.(37.4±2.4)周,(3 282.0±523.4)g vs.(2 937.9±645.5)g](P<0.001)。结论对于年龄<35岁、卵巢储备正常,新鲜周期未移植且为第一次复苏周期D5囊胚移植的患者,可以建议行D5单囊胚移植,其能获得与D5双囊胚移植相似的活产率,并能显著降低多胎率、延长孕周并改善新生儿出生体重。

Objective： To explore the impact of Day 5single blastocyst transfer（SBT）or double blastocysts transfer（DBT）in frozen embryo transfer cycles on pregnancy outcome among infertility patients aged less than 35 years old with normal ovarian reserve.Methods： The pregnancy outcomes of 446 frozen Day 5 blastocyst transfers cycles in infertility patients aged less than 35 years with normal ovarian reserve from January 2013 to April 2015 were retrospectively analyzed.The patients were divided into two groups based on the number of Day 5blastocyst transferred.The pregnancy outcomes between SBT group and DBT group were compared.Results： No difference were observed in biochemical pregnancy rate,clinical pregnancy rate,live birth rate,ectopic pregnancy rate,miscarriage rate and monozygotic twin rate between SBT group and DBT group（P〉0.05）.However,the multiple pregnancy rate in DBT group was significantly higher than that in SBT group（52.6% vs.2.4%）（P〈0.001）.In addition,the implantation rate in SBT group was significantly higher than that in DBT group（79.2% vs.57.5%）（P〈0.001）.The analysis of live born children＇s basic characteristic showed that mean gestational age in SBT group was significantly longer that in DBT group[（38.6±2.1）vs.（37.4±2.4）weeks]（P〈0.001）.The mean neonatal weight in SBT group was significantly heavier than that in the DBT group [（3 282.0±523.4）vs.（2 937.9±645.5）g]（P〈0.001）.Conclusions： For the patients less than 35 years old,with normal ovarian reserve,in the first frozen embryo transfer cycle,without fresh embryo transfer,the Day 5single blastocyst transfer is recommended.Day 5single frozen blastocyst transfer can significantly decrease multiple birth risk,prolong gestational weeks and improve fetal weight,while providing similar live birth rate compared to DBT.