冻融胚胎移植对妊娠早期胚胎流产率的影响

Influence of frozen-thawed embryo transfer on abortion rate at early pregnancy

目的研究冻融胚胎移植是否增加早期妊娠胚胎流失率。方法回顾性分析2012年1月至2016年12月在本中心接受胚胎移植的6 834周期临床妊娠患者的资料,根据移植胚胎分为新鲜胚胎移植组(鲜胚组)和冻融胚胎移植组(冻胚组),比较鲜胚组与冻胚组种植胚胎流失率、流产率和活产率。另外根据移植胚胎级别分为卵裂期胚胎移植(D3组)和囊胚期胚胎移植(D5组),分别比较D3组鲜胚和冻胚以及D5组鲜胚与冻胚的种植胚胎流失率、流产率和活产率。结果鲜胚组和冻胚组患者年龄、不育年限无显著性差异(P>0.05);胚胎流失率分别为18.9%和24.3%,流产率分别为14.4%和17.1%,活产率分别为85.6%和82.9%,差异均有统计学意义(P<0.05);D3组患者鲜胚与冻胚种植胚胎流失率、流产率和活产率分别为19.4%vs.30.0%、14.5%vs.19.6%和85.5%vs.80.4%,差异有统计学意义(P<0.05);D5组患者鲜胚与冻胚种植胚胎流失率、流产率和活产率差异无统计学意义(P>0.05)。结论与新鲜胚胎移植周期相比,冻融胚胎移植可能会增加妊娠早期胚胎流失率和流产率,降低活产率;因此在IVF周期中应尽量选择新鲜胚胎移植,如果选择冻融胚胎移植,应尽可能选择冻融囊胚期胚胎移植。

Objective:To study weather frozen-thawed embryo transfer increase abortion rate comparing with fresh embryo transfer.Methods:A retrospective analysis was conducted on the clinical data of 6 834 clinical pregnancy patients undergone IVF,including 4 212 fresh embryo transfer cycles and 2 262 frozen-thawed embryo transfer cycles.The first trimester miscarriage rate,abortion rate and live birth rate were compared between fresh embryo transfer group and frozen embryo transfer group.In addition,the embryos transferred were divided into cleavage stage transfer group(Day 3 group)and blastocyst transfer group(Day 5 group)according to the stage of embryo transferred.The first trimester miscarriage rate,abortion rate and live birth rate were compared between fresh embryo transfer and frozen embryo transfer in the Day 3 group,as well as in the Day 5 group.Results:There was no significant difference in age and infertility duration between fresh embryo group and frozen embryo group(P>0.05).The first trimester miscarriage rate(18.9%vs.24.3%)and abortion rate(14.4%vs.17.1%)were significantly lower,but the live birth rate(85.6%vs.82.9%)was significantly higher in fresh embryo transfer group than that in frozen embryo transfer group(P<0.05).There were significantly differences in the first trimester miscarriage rate(19.4%vs.30.0%),abortion rate(14.5%vs.19.6%)and live birth rate(85.5%vs.80.4%)between fresh embryo transfer and frozen embryo transfer in Day 3 group(P<0.05).However,there were no significantly differences in the first trimester miscarriage rate(17.0%vs.20.2%),abortion rate(14.0%vs.15.3%)and live birth rate(86.1%vs.84.7%)between fresh embryo transfer and frozen embryo transfer in Day 5 group(P>0.05).Conclusions:The frozen-thawed embryo transfer may increase the first trimester miscarriage rate and abortion rat,but reduce the live birth rate comparing with fresh embryo transfer.Therefore,the fresh embryo transfer should be chosen firstly in the IVF cycle.If the frozen-thawed embryo transfer is chosen,it is better to select the blastocyst transfer.