胚胎解冻移植对体外受精/卵胞浆内单精子显微注射助孕累积活产率的影响

Influence of frozen-thawed embryo transfer on cumulative live birth rate after in vitro fertilization/intracytoplasmic sperm injection

目的考察胚胎解冻移植(FET)对卵巢正常反应人群首次促排周期累积活产率的影响。方法选择2016年1月1日至12月31日就诊于空军军医大学唐都医院接受体外受精/卵胞浆内单精子显微注射(IVF/ICSI)的不孕症患者。纳入年龄20~39岁、卵巢储备功能正常及首次促排周期的患者,排除捐卵周期、卵巢储备功能低下、多囊卵巢综合征及首次促排周期后未行胚胎移植者。采用logistic回归分析研究FET对IVF/ICSI助孕的累积活产率和流产率的影响。结果共纳入患者1141例,包括377个新鲜胚胎移植周期及764个FET周期。FET周期患者平均年龄为(29.85±3.68)岁,平均BMI为(22.06±2.81)kg/m^2,平均促排天数为(11.28±2.16)d,平均促性腺激素使用量为(1862.04±863.21)U、平均获卵数为(15.14±5.45)个。新鲜胚胎移植周期和FET周期的累积活产率与流产率的差异均无统计学意义[68.44%(258/377)vs 66.10%(505/764),P=0.430;5.31%(20/377)vs 8.38%(64/764),P=0.062]。Logistic回归分析结果显示,与新鲜胚胎移植相比,FET未改善IVF/ICSI助孕的累积活产率[OR=0.99,95%CI 0.73~1.34,P=0.936],有增加IVF/ICSI助孕流产率的趋势但无统计学意义(OR=1.57,95%CI 0.87~2.82,P=0.130)。结论FET未能改善IVF/ICSI助孕的累积活产率,但有增加IVF/ICSI助孕流产率的趋势。建议医师和患者应慎重做出全胚冷冻的临床决策,仅在非常必要时,如有卵巢过度刺激综合征高风险因素、需进行胚胎植入前遗传学筛查或参与前瞻性随机对照试验的情况下可采用全胚冷冻的移植策略。

Objective To evaluate the influence of frozen-thawed embryo transfer(FET)on the cumulative live birth rate(cLBR)of the first cycle of controlled ovarian hyperstimulation in normal ovarian responsers.Methods Infertile patients who received in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)in Tangdu Hospital of Air Force Medical University from January 1 to December 31,2016 were enrolled in this retrospective cohort study.Inclusion criteria:aged 20-39 years,normal ovarian reserve,and the first controlled ovarian hyperstimulation.Exclusion criteria:donor cycles,impaired ovarian reserve,polycystic ovarian syndrome or no embryo transfer after the first oocyte retrieval cycle.Logistic analysis was employed to explore the influence of FET on the cLBR and miscarriage rate after IVF/ICSI.Results A total of 1141 patients who met the inclusion criteria were enrolled in this cohort,including 377 fresh embryo transfer cycles and 764 FET cycles.In FET cycles,the mean age of the patients was(29.85±3.68)years old,the mean body mass index was(22.06±2.81)kg/m2,the mean duration of controlled ovarian hyperstimulation was(11.28±2.16)d,the mean dose of gonadotropin was(1862.04±863.21)U,and the mean number of oocytes retrieved was 15.14±5.45.There was no statistical difference in the cLBR or miscarriage rate between fresh embryo cycles and FET cycles(68.44%[258/377]vs 66.10%[505/764],P=0.430;5.31%[20/377]vs 8.38%[64/764],P=0.062).Logistic regression analysis results showed no beneficial effect of FET on the cLBR when compared to the fresh embryo transfer(odds ratio[OR]=0.99,95%confidence interval[CI]0.73-1.34,P=0.936);however,there was a trend that FET could increase the risk of miscarriage rate(OR=1.57,95%CI 0.87-2.82,P=0.130).Conclusion FET cannot improve the cLBR after IVF/ICSI,but it might increase the miscarriage rate.Patients and clinicians should be very cautious when the“freeze all”strategy is about to be chosen.FET can be recommended only in case of high risk of ovarian hyperstimulation syndrome,pre-implantation genetic testing or prospective randomized controlled trial.