新鲜周期卵裂胚移植策略对35～38岁患者妊娠结局的影响

Impact of fresh cleavage-stage embryo transfer policy on pregnancy outcomes in women aged 35-38 years

目的探讨不同的新鲜周期卵裂胚移植策略对35~38岁患者妊娠结局的影响。方法回顾性分析2015年3~12月和2016年3~12月在中山大学附属第一医院生殖医学中心首次行新鲜周期卵裂胚移植的患者的临床资料。2015年3~12月行鲜胚移植的210例为A组,2016年3~12月行鲜胚移植的241例为B组;A组中移植3个卵裂胚的140例为A1组,B组中移植2个卵裂胚的225例为B1组,比较各组患者的基本资料和妊娠结局。结果 A、B组患者Gn天数及用量、获卵数、正常受精数、可利用胚胎数和优质胚胎数等比较均无显著性差异(P>0.05);B组的平均移植胚胎数[(1.9±0.2)个]显著低于A组[(2.6±0.6)个](P<0.05)。A、B两组的种植率、临床妊娠率、早期流产率和活产率比较均无显著性差异(P>0.05);B组的多胎率(29.20%)显著低于A组(43.64%)(P<0.05)。A1组的获卵数和可利用胚胎数显著高于B1组(P<0.05);两组的种植率、临床妊娠率、早期流产率和活产率比较无显著性差异(P>0.05);B1组的多胎率(30.28%)显著低于A1组(49.38%)(P<0.05)。结论新的卵裂胚移植策略减低了35~38岁首次行新鲜卵裂胚移植患者的移植胚胎数,降低了多胎率,但对种植率、临床妊娠率和活产率无明显影响。

Objective： To explore the impact of fresh cleavage-stage embryo transfer policy on pregnancy outcomes in women with 35-38 years old.Methods： The data of infertile women with 35-38 years old in the first fresh cleavage-stage embryo transfer cycles in the First Affiliated Hospital of Sun Yat-sen University from March to December 2015 and from March to December in 2016 were retrospectively analyzed.There were 210 fresh embryo transfer cycles from March to December 2015（group A）,and 140 cycles with three embryos transferred in group A were group A1.There were 241 fresh embryo transfer cycles from March to December in 2016（group B）,and 225 cycles with two transferred embryos in group B were group B1.The basic characteristics and pregnancy outcomes were compared among the groups.Results：There was no significant difference in days and doses of gonadotropin（Gn）used,the number of oocytes retrieved,the number of normal fertilization,the number of embryos available and the number of high-quality embryos between group A and B（P〈0.05）.The average number of embryos transferred in group B[（1.9±0.2）]was significantly lower than that in group A[（2.6±0.6）]（P〈0.05）.There were no significant differences in the implantation rate,clinical pregnancy rate,early miscarriage rate and live birth rate between groups A and B（P〈0.05）.The multiple birth rate in group B（29.20%）was significantly lower than that in group A（43.64%）（P〈0.05）.The number of oocytes retrieved and embryos available in group A1 were significantly higher than those in group B1（P〈0.05）.There was no significant difference in the implantation rate,clinical pregnancy rate,early miscarriage rate and live birth rate between the two groups（P〉0.05）.The multiple birth rate in group B1（30.28%）was significantly lower than that in group A1（49.38%）（P〈0.05）.Conclusions：New policy of cleavage-stage embryo transfer reduced the number of embryos transferred in women with 35-38 years old in their first fresh transfer cycle,and reduced the multiple pregnancy rate,but had no significant influence on pregnancy rate and live birth rate.