35周岁以下女性囊胚冻融周期移植策略的探讨

The strategy of frozen-thawed blastocyst transfer in women less than 35 years old

目的探讨35周岁以下女性囊胚冻融周期移植策略,以期为保证单个移植周期妊娠率提供参考。方法选择2015年1月1日至2016年10月1日在本院生殖中心行冻融囊胚移植、年龄<35岁的患者,共1 539个移植周期。根据囊胚移植数目和囊胚等级分为4组:单优质囊胚移植组(单优组)、双优质囊胚移植组(双优组)、单非优质囊胚移植组(单非优组)、双非优质囊胚移植组(双非优组)。比较4组的临床妊娠率、种植率、早期流产率、继续妊娠率和双胎率。结果双优组的临床妊娠率(77.9%)、种植率(61.0%)、继续妊娠率(90.8%)显著高于单优组、单非优组、双非优组(P均<0.05),早期流产率(8.3%)显著低于其它3组(P<0.05),但双胎率(47.6%)亦显著高于其它3组(P<0.05)。单优组的临床妊娠率(51.6%)、继续妊娠率(80.1%)和早期流产率(18.5%)与双非优组(分别为49.6%、80.2%、18.9%)比较无显著差异(P>0.05),但双胎率(2.7%)显著低于双非优组(27.0%)(P<0.05)。单非优组的双胎率(1.4%)与单优质组(2.7%)相似,均显著低于双优组、双非优组,但临床妊娠率(37.6%)亦显著低于其它3组(P<0.05)。结论 35周岁以下女性囊胚冻融移植周期中,可优先选择移植1个优质冻融囊胚;当无优质冻融囊胚时,可选择移植2个非优质冻融囊胚以保证一定的单个移植周期妊娠率。

Objective： To investigate the strategy of frozen-thawed blastocyst transfer in women less than 35 years old,in order to provide guideline for maintaining a certain pregnancy rate of single transfer cycle.Methods： The young women less than 35 years old came to the reproductive center of Shenzhen Zhongshan Urology Hospital from Jan.1 2015 to Oct.1 2016 were enrolled in this study.The data of 1 539frozen-thawed blastocyst transfer cycles were analyzed.The transfer cycles were divided into four groups according to the quantity and quality of blastocyst：single high-quality blastocyst group,double high-quality blastocysts group,single poor-quality blastocyst group,and double poor-quality blastocysts group.The clinical pregnancy rate,implantation rate,early miscarriage rate,ongoing pregnancy rate and twin pregnancy rate were compared among the four groups respectively.Results： The clinical pregnancy rate（77.9%）,implantation rate（61.0%）,ongoing pregnancy rate（90.8%）in double high-quality group were significantly higher than those in single high-quality group,single poor-quality group and double poor-quality group（P〈0.05）.The early miscarriage rate（8.3%）was significantly lower than those in other three groups,while the twin pregnancy rate（47.6%）was significantly higher than those in other three groups（P〈0.05）.The clinical pregnancy rate（51.6%vs.49.6%）,ongoing pregnancy rate（80.1% vs.80.2%）,early miscarriage rate（18.5% vs.18.9%）in single high-quality group were not significantly different to those in double poor-quality group（P〉0.05）,while the twin pregnancy rate was significantly lower than that in double poor-quality group（2.7%vs.27.0%,P〈0.05）.The twin pregnancy rate in single poor-quality group（1.4%）was similar to single high-quality group（2.7%）,but it was significantly lower than double high-quality group and double poorquality group,while the pregnancy rate（37.6%）was yet significantly lower than that in other three groups（P〈0.05）.Conclusions： Single high-quality frozen-thawed blastocyst can be preferred to transplant for women less than age 35 years.Two poor-quality frozen-thawed blastocysts may be chosen to transfer in order to improve the pregnancy rate of single transfer cycle,if there is no high-quality frozen-thawed blastocyst available.