基于倾向性评分匹配法探讨冻融胚胎移植对妊娠早期胚胎停育的影响

The Eeffect of Frozen-thawed Embryo Transfer on Embryo Arrest in Early Pregnancy Based on Propensity Score Matching

目的:比较冻融胚胎与新鲜胚胎移植对早期胚胎停育的影响。方法:回顾性分析2010年1月至2016年12月本中心获得临床妊娠的5 971助孕周期,根据移植周期类型分为冻胚移植组(n=2 332)和鲜胚移植组(n=3639),使用倾向性评分匹配法对两组患者进行匹配,得到组间协变量均衡的样本,通过单因素和多因素logistic回归分析匹配前后冻融胚胎移植对妊娠早期胚胎停育发生率的影响。结果:匹配前与鲜胚组相比,冻胚组年龄更大,囊胚期胚胎移植比例更高,移植胚胎数和胚胎种植数更多。使用倾向性匹配法,两组患者共有1 139对匹配成功,两组间不平衡的协变量达到平衡,匹配前鲜胚组与冻胚组胚胎停育发生率17%vs 26.3%(P<0.05),OR=1.550,95%CI=1.404～1.712。匹配后鲜胚组与冻胚组胚胎停育发生率19.7%vs 25.5%(P<0.05),OR=1.290,95%CI=1.106～1.505。校正年龄及其他临床因素后多因素logistic回归分析显示冻胚组胚胎停育发生率显著高于鲜胚组(匹配前OR=1. 515,95%CI=1.299～1.767;匹配后OR=1.409,95%CI=1.151～1.724)。结论:辅助生殖技术助孕中,冻融胚胎移植可能增加早期胚胎停育的发生,降低患者最终的活产率。年龄和多胎妊娠也是导致胚胎停止发育的重要因素。

Objective To compare the effects of frozen-thawed embryo transfer and fresh embryo transfer on early embryo sterilization. Methods A retrospective analysis was conducted on 5 971 assisted pregnancy cycles from January 2010 to December 2016. According to the type of transplantation cycles,the patients were divided into frozen embryo transplantation group( n = 2 332) and fresh embryo transplantation group( n = 3 639). The patients of the two groups were matched by propensity score matching method,and the samples of covariate equilibrium between groups were obtained. Univariate and multivariate logistic regression analysis was used to analyze the effect of frozen-thawed embryo transfer before and after matching on the incidence of embryo sterilization in early pregnancy. Results Compared with the fresh embryo group before matching,frozen embryo group was older,blastocyst embryo transfer rate was higher,the number of transferred embryos and embryo implantation were more. By propensity matching method,1139 pairs of matches were successful in both groups.The unbalanced covariates between the two groups were balanced. Before matching,the incidence of embryo sterilization in fresh embryo group and frozen embryo group was 17% vs 26.3%( P< 0.05),OR = 1.550,95% CI = 1.404 ~ 1.712. After matching,the incidence of embryo sterilization in fresh embryo group and frozen embryo group was 19.7% vs 25.5%( P<0. 05),OR = 1.290,95%CI = 1.106 ~ 1.505. After adjusting for age and other clinical factors,multivariate logistic regression analysis showed that the incidence of embryo arrest in frozen embryo group was significantly higher than that in fresh embryo group( OR = 1515,95%CI = 1.299 ~ 1.767 before matching,OR = 1.409 after matching,95%CI = 1.151 ~ 1.724).Conclusion In assisted reproductive technology,frozen-thawed embryo transfer may increase the occurrence of early embryo withdrawal and reduce the final live birth rate of patients. Age and multiple pregnancies are also important factors leading to the cessation of embryonic development.