取消新鲜胚胎移植后冷冻胚胎移植时机选择及其对妊娠结局的影响

The “Timing” of The First Frozen-thawed Embryo Transfer after a Cancelled Fresh Embryo Transfer

【目的】探讨取消新鲜胚胎移植后冷冻胚胎移植时机是否对临床妊娠率及活产率有影响。【方法】回顾性分析2014年1月至2015年12月期间本中心行体外受精-胚胎移植技术(IVF-ET)的患者资料,取消新鲜胚胎移植后行冻胚移植共1 785周期,共355周期纳入本研究。以促排周期取卵日与第一次冷冻胚胎移植日的间隔时间进行分组,小于等于45 d为邻近组(n=79),大于45 d为非临近组(n=276)。同时将两组按促排方案各自再分为两个亚组,促性腺激素释放激素激动剂方案(简称激动剂方案)临近组(n=44)、和非临近组(n=191),促性腺激素释放激素拮抗剂方案(简称拮抗剂方案)临近组(n=35)和非临近组(n=85)。主要观察指标为临床妊娠率(CPR)、活产率(LBR),分析各组及亚组间的差异。【结果】临近组与非临近组研究对象的年龄、不孕年限、不孕因素、体质量指数(BMI)、基础卵泡刺激素(FSH)值、促性腺激素(Gn)总量、HCG日孕酮(P)水平及获卵数等结果差异无统计学意义(P>0.05)。而窦卵泡计数(AFC)、HCG日E2水平、Gn时间、促排卵方案、以及FET内膜准备方案的差异有统计学意义(P<0.05),其中临近组多囊卵巢综合征患者较非临近组多(50.6%vs.30.8%,P=0.001)。临近组与非临近组的临床妊娠率(51.9%vs.48.2%,P=0.561)、活产率(43.0%vs.38.4%,P=0.458)差异无统计学意义。比较不同促排卵方案亚组,激动剂方案:临近组与非临近组的临床妊娠率(52.3%vs.46.6%,P=0.497)和活产率(45.5%vs.36.6%,P=0.279);拮抗剂方案:临近组与非临近组的临床妊娠率(51.4%vs.51.8%,P=0.973)和活产率(40.0%vs.42.4%,P=0.812),差异均无统计学意义。【结论】IVF周期取消移植后立即行FET的CPR和LBR与至少经历一次月经后的FET无明显无差异。

【Objective】To investigate whether the time interval between a cancelled fresh embryo transfer and a subsequent frozen embryo transfer（FET）affects clinical pregnancy rate（CPR）and live birth rate（LBR）.【Methods】A total of 1 785 FET cycles were performed between January 2014 to December 2015 in our reproductive center,with 355 FET cycles being retrospectively analyzed. Samples were divided according to the interval between oocyte retrieval（OR）and subsequent FET. FET at ≤ 45 days from OR was defined as adjacent FET（n = 79）and FET at 〉45 days from OR day was defined as non-adjacent FET（n = 276）. Meanwhile,each group were divided according to ovarian stimulation protocol,including adjacent FET（n = 44）and non-adjacent FET（n = 191）followed Gn RH-a protocol in IVF cycles,adjacent FET（n = 35）and non-adjacent FET（n = 85）followed Gn RH-antagonist protocol in IVF cycles. Main outcomemeasure：CPR and LBR.【Results】No significant difference was observed in duration of infertility,body mass index（BMI）,basal follicle stimulating hormone（b FSH）,total gonadotropin（Gn） dosage,progesterone（P） on human chorionic gonadotropin（HCG）day,number of OR between adjacent FET and non-adjacent FET. Compared with nonadjacent FET,number of antral follicle count（AFC）and days of Gn were significantly more and E2 on HCG day was higher in adjacent FET. Prevalence of protocol for ovarian stimulation protocol and endometrial preparation also significantly differ between the two groups. Prevalence of polycystic ovary syndrome（PCOS）was significant higher in adjacent FET than in non-adjacent FET. No significant difference was found in CPR and LBR between adjacent FET and non-adjacent FET（51.9% vs 48.2%,P = 0.561,and 43.0% vs 38.4%,P = 0.458,respectively）. No significant difference was found in CPR and LBR between adjacent FET and non-adjacent FET follow Gn RH-a protocol（52.3% vs46.6%,P = 0.497,and 45.5% vs 36.6%,P = 0.279,respectively）. No significant difference was found in CPR and LBRs between adjacent FET and non-adjacent FET follow Gn RH-antagonist protocol（51.4% vs 51.8%,P = 0.973,and40.0% vs 42.4%,P = 0.812,respectively）.【Conclusions】FET performed at least one menstrual cycle had CPR and LBR similar to immediately FET after fresh IVF cycle.