不同移植方案对高龄患者冻胚移植妊娠结局的影响

The pregnancy outcomes of frozen-thawed embryo transfer in elder patients under different protocols

目的探讨不同移植方案对高龄患者冻融胚胎移植(FET)妊娠结局的影响。方法回顾性分析行FET高龄患者的临床资料,共1 820个周期。按内膜准备方案和移植胚胎类型分为自然周期卵裂胚移植组(自然周期A组,共511个周期)、自然周期囊胚移植组(自然周期B组,共231个周期)、激素替代治疗(HRT)周期卵裂胚移植组(激素替代A组,共811个周期)、HRT囊胚移植组(激素替代B组,共267个周期),比较4组的着床率、临床妊娠率、异位妊娠率、流产率、早产率、活产率及多胎妊娠率。结果自然周期A组的流产率和活产率(20.5%vs 22.0%)与激素替代A组(33.5%vs 16.5%)间差异有统计学意义(P<0.05),两组间着床率、临床妊娠率、异位妊娠率、早产率及多胎妊娠率差异均无统计学意义。自然周期B组与激素替代B组间着床率、临床妊娠率、异位妊娠率、流产率、早产率、活产率及多胎妊娠率差异均无统计学意义。自然周期B组和激素替代B组着床率、临床妊娠率、活产率均显著高于自然周期A组和激素替代A组(P<0.05),但异位妊娠率、流产率、多胎妊娠率间差异无统计学意义。结论高龄患者行冻融囊胚移植时无论采用自然还是HRT周期均可获得较好的临床结局,而冻融卵裂胚移植自然周期方案优于HRT方案。

Objective To compare the pregnancy outcomes of frozen-thawed embryo transfer(FET)in elder patients under different protocols.Methods The date of 1 820 FET cycles in elder patients were analyzed retrospectively.According to the endometrial preparation scheme and the type of embryo transferred,all subjects were divided into four groups:transferring cleavage-stage embryo in natural cycle(group natural cycle A,n=511),transferring blastocyst in natural cycle(group natural cycle B,n=231);transferring cleavage-stage embryo in hormone replacement treatment(HRT)cycle(group HRT A,n=811)and transferring blastocyst in HRT cycle(group HRT B,n=267).Embryo implantation rate,clinical pregnancy rate,ectopic pregnancy rate,abortion rate,premature birth rate,live birth rate and multiple pregnancy rate were compared among the four groups.Results Group natural cycle A had lower abortion rate and higher live birth rate than group HRT A(P<0.05),while there were no significant differences in the rates of embryo implantation,clinical pregnancy,ectopic pregnancy,premature birth and multiple pregnancy between two groups.There were no significant difference in embryo implantation rate,clinical pregnancy rate,ectopic pregnancy rate,abortion rate,premature birth rate,live birth rate and multiple pregnancy rate between group natural cycle B and group HRT B.Embryo implantation rate,clinical pregnancy rate and live birth rate in group natural cycle B and group HRT B were significantly higher than those in group natural cycle A and group HRT A,respectively(P<0.05),whereas the ectopic pregnancy rate,abortion rate and multiple pregnancy rate showed no significant differences between this groups.Conclusion The natural clinical outcomes of the frozen-thawed blastocyst transplantation in elderly patients should be satisfied regardless of natural or HRT cycle,and the natural cycle scheme of freeze-thaw cleavage embryo transplantation is superior to that of HRT.