冻融胚胎移植中辅助孵化对妊娠结局及安全性的影响

Effect of assisted hatching on the outcome and security of frozen-thawed embryo transfer

目的探讨在玻璃化冻融胚胎移植(FET)中,激光辅助孵化(AH)操作后对妊娠结局及母儿安全性的影响。方法回顾性分析2014年1月—2015年10月接受体外受精-胚胎移植(IVF-ET)失败后行FET患者的临床资料,根据患者年龄进行分组后比较AH操作后妊娠结局及母儿并发症的发生情况。结果在正常年龄组(<38岁)的患者中,未行AH操作的对照组中胚胎种植率、临床妊娠率、活产率、多胎率均高于AH组,流产率低于AH组,并且差异有统计学意义(P<0.05);在高龄(≥38岁)患者中,AH组的胚胎种植率、临床妊娠率较对照组有增高的趋势(P>0.05);分娩周期中,AH组与对照组早产率、死胎率、母体并发症、新生儿男女比例、胎龄、出生体质量、新生儿缺陷率等均无统计学差异(P<0.05)。结论对于正常年龄患者,卵裂期FET时不建议行AH操作;对于高龄患者,AH操作可提高胚胎种植率及临床妊娠率,但不能明显改善其妊娠结局;AH对母儿安全暂无不良影响。

Objective To investigate the effect of laser-assisted hatching（AH） on outcome and security in frozen-thawed embryo transfer（FET）. Methods The medical information of FET patients was retrospectively analyzed from pregnant cases undergoing in vitro fertilization-embryo transfer（IVF-ET） from January 2014 to October 2015. The incidence of pregnancy outcomes and maternal and fetal security were compared between AH group and control group（non-AH group）. Results In control group with the normal age patients（〈38 years old）, the embryo implantation rate, the clinical pregnancy rate, the live birth rate and the multiple pregnancy rate were higher than those in AH group, and the abortion rate was lower in control group（P〈0.05）. In elderly patients（≥38 years old）, the embryo implantation rate and the clinical pregnancy rate were increased in AH group, but there were no significant differences（P〉0.05）. There was no significant difference in premature delivery, stillbirth rate, maternal complications, gender, gestational age, birth weight, birth defects rate between AH group and control group in delivery cycles（P〉0.05）. Conclusion There is no benefit to improve pregnancy outcome in the normal age patients when FET used AH. For elderly patients, AH operation may improve the implantation rate and the clinical pregnancy rate, but it did not improve the clinical outcome. The long-term safety need more cumulate data and research.