剖宫产史对体外受精鲜胚移植妊娠结局的影响

Effect of cesarean section history on pregnancy outcomes in IVF-ET

目的 探讨体外受精-胚胎移植(IVF-ET)周期中,既往剖宫产史对IVF鲜胚移植周期临床妊娠结局的影响。 方法 回顾性分析2015年1月1日至2018年9月30日期间在我院生殖中心进行IVF助孕治疗的1987例患者的临床资料,根据既往不同的分娩史将患者分为剖宫产史组(756例)和阴道分娩史组(1231例)。比较两组患者IVF鲜胚移植周期的临床妊娠结局。 结果 剖宫产组临床妊娠共373人,临床妊娠率49.34%;阴道分娩史组临床妊娠共713人,临床妊娠率57.92%,两组间总临床妊娠率比较有显著性差异(P<0.05)。两组间囊胚移植妊娠结局比较,阴道分娩史组的双囊胚移植早期流产率显著低于剖宫产史组(P<0.05),但单囊胚移植临床妊娠率、双胎率、早期流产率、异位妊娠率及双囊胚移植其他各指标间比较均无显著性差异(P>0.05)。两组间卵裂期胚胎移植妊娠结局比较,阴道分娩史组的总妊娠率、双卵裂胚移植的妊娠率及双胎妊娠率均显著高于剖宫产史组(P<0.05),但单卵裂胚移植临床妊娠率、双胎率、早期流产率、异位妊娠率在两组间比较均无显著性差异(P>0.05)。 结论 剖宫产史并不明显影响IVF助孕单卵裂期胚胎/单囊胚鲜胚移植的临床妊娠结局,双卵裂期胚胎及双囊胚移植后的临床妊娠结局差异是否与剖宫产史有关还需要进一步证实。

Objective : To investigate the effect of previous cesarean section on the clinical pregnancy outcome in the fresh embryo transfer cycle. Methods : The data of 1 987 women who received IVF treatment in assisted reproduction center of Northwest Women ’s and Children ’s Hospital were retrospectively analzed.The patients were divided into two groups according to the different birth history:cesarean section group( n =756)and vaginal delivery group( n =1 231).The clinical pregnancy outcomes in the fresh embryo transfer cycles were compared between the two groups. Results : There were 373 clinical pregnancies in the cesarean section group with the clinical pregnancy rate of 49.34%,and 713 clinical pregnancies in the gestational gestation group with the clinical pregnancy rate of 57.92%.There was a significant difference in the total clinical pregnancy rate between the two groups( P <0.05).Compared with the outcome of blastocyst transfer in the two groups,the early abortion rate of double blastocyst transfer in the vaginal delivery group was significantly lower than that in the cesarean section( P <0.05).However,there was no significant difference in clinical pregnancy rate,twin pregnancy rate,early abortion rate,ectopic pregnancy rate of single blastocyst transfer and other indexes of double blastocyst transfer( P >0.05).Comparison of the pregnancy outcome of cleavage stage embryo transfer between the two groups,the total pregnancy rate,the pregnancy rate of double blast embryo transfer and the twin pregnancy rate in the vaginal delivery group were significantly higher than the cesarean section group( P <0.05),but the clinical pregnancy rate,twin rate,early abortion rate and ectopic pregnancy rate of single cleavage embryo transfer were not significantly different between the two groups( P >0.05). Conclusions : A previous cesarean delivery does not affect the clinic pregnancy outcomes single embryo/blastocyst transfer in the fresh IVF cycle.Whether the difference in clinical pregnancy outcome between the double cleavage stage embryo and the double blastocyst transfer is related to the history of cesarean section needs further confirmation..