拮抗剂方案FET与新鲜周期移植结局的比较

Comparing the outcomes of FET in antagonist protocol and fresh cycle embryo transfer

目的比较拮抗剂方案全胚冷冻后第一次冻融胚胎移植(FET)与新鲜周期移植结局。方法回顾性分析2016年1至12月在西北妇女儿童医院生殖中心行体外受精-胚胎移植(IVF-ET)患者的拮抗剂新鲜周期移植及全胚冷冻后第一次FET的数据,共896个移植周期。按照是否全胚冷冻分为两组,A组为全胚冷冻后第一次FET,B组为拮抗剂新鲜移植组。分析两组间年龄、基础促卵泡素(bFSH)、基础窦卵泡数(AFC)、身体质量指数(BMI)、促性腺激素(Gn)刺激天数、Gn用量、获卵数、正常受精(2PN)率、优胚率、囊胚形成率、种植率、临床妊娠率等。结果 (1)两组患者的年龄、不孕年限、bFSH、AFC、BMI差异均无统计学意义(均P>0.05);(2)两组的促排卵后Gn用量、Gn天数及人绒毛膜促性腺激素(hCG)日雌二醇(E2)值、移植日内膜厚度、获卵数、移植胚胎数差异亦均无统计学意义(均P>0.05);(3)两组2PN率、囊胚形成率差异均无统计学意义(均P>0.05),但B组优胚率显著高于A组(χ2=11.356,P<0.05);(4)A组种植率、临床妊娠率均显著高于B组(χ2值分别为18.451、9.671,均P<0.05),两组早期流产率差异无统计学意义(P>0.05)。结论拮抗剂方案全胚冷冻后,FET较新鲜移植能够获得更好的结局。

Objective To compare the outcomes of first frozen thawed embryo transfer（FET）after whole embryo vitrification and fresh cycle embryo transplantation in antagonist protocol.Methods Data of antagonist protocol fresh cycle embryo transplantation and first FET after whole embryo vitrification in patients receiving in vitro fertilization embryo transfer（IVF-ET）from January to December 2016 in reproductive center of Northwest Women and Children＇s Hospital were analyzed retrospectively,including 896 cycles.Cases were divided into two groups according to whether whole embryo freezing was performed.Group A received first FET after all embryo vitrification,and group B received fresh cycle transfer.Age,basic follicle stimulating hormone（bFSH）,basic antral follicle count（AFC）,body mass index（BMI）,gonadotropin（Gn）stimulating days,Gn dosage,number of retrieved oocytes,normal fertilization rate,good quality embryo rate,blastocyst formation rate,implantation rate,pregnancy rate were compared between two groups.Results There were no significant differences in age,infertile period,bFSH level,AFC and BMI between two groups（all P〉0.05）.There were no significant differences in dosages of gonadotropin（Gn）after ovarian stimulation,Gn stimulating days,estradiol（E2）level on human chorionic gonadotropin（hCG）administration day,endometrial thickness on day of embryo transfer,number of retrieved oocytes and number of transferred embryo between two groups（all P〉0.05）.The differences in normal fertilization rate and blastocyst formation rate were also not significant between two groups（P〉0.05）.but good quality embryo rate was higher in group B than in group A（χ2=11.356,P〈0.05）.Implantation rate and clinical pregnancy rate in group A were significantly higher than those in group B（χ2 value was 18.451 and 9.671,respectively,both P〉0.05）,but early abortion rate in two groups had no significant difference（P〉0.05）.Conclusion FET following whole embryo frozen has better outcomes than that of fresh cycle transfer in antagonist protocol.