体外受精-胚胎移植技术中失独女性胚胎移植策略的选择

Transplantation strategy of IVF-ET for women bereaved of their only child

目的探讨失独患者接受IVF助孕时新鲜移植及冻融胚胎移植(FET)周期的妊娠结局,以期为失独女性胚胎移植策略的选择提供参考。方法回顾性分析2013年12月至2019年3月我院生殖中心接收IVF助孕失独患者(共366个周期)的临床资料,根据不同的移植周期分为两组:新鲜组(114个新鲜周期),FET组(252个FET周期),比较两组患者的基线资料以及妊娠结局,构建多因素回归模型分析妊娠结局的影响因素;并对年龄进行分层,比较不同年龄(<35岁、35~39岁、40~44岁、≥45岁)中两组患者的临床妊娠率和活产率。结果FET组的男、女方年龄显著高于新鲜组,移植优胚数显著低于新鲜组(P<0.05);新鲜组的生化妊娠率(33.33%vs.24.60%)、临床妊娠率(27.19%vs.20.63%)及胚胎种植率(16.84%vs.12.78%)略高于FET组,早期妊娠丢失率(21.05%vs.33.87%)略低于FET组,但均无显著性差异(P>0.05)。FET组活产率显著低于新鲜组(12.30%vs.20.18%,P<0.05)。不同年龄分层各组中新鲜组和FET组的临床妊娠率及活产率比较均无显著性差异(P>0.05);但35~39岁组中新鲜组的临床妊娠率及活产率均略高于FET组(57.89%vs.32.35%及47.37%vs.25.81%),尚无显著性差异(P>0.05)。以活产为因变量进行Logistic回归分析显示仅女性年龄为活产的独立影响因素(OR=0.859,95%CI:0.750-0.983,P=0.027)。结论失独患者IVF助孕胚胎移植策略中,新鲜移植周期比FET周期可能会获得较好的妊娠结局,但该结果尚需更大样本量的前瞻性研究加以探讨验证。

Objective:To investigate the pregnancy outcome between fresh embryo and frozen embryo transfer(FET)for women bereaved of their only child,in order to provide a reference for the selection of embryo transfer strategies for them.Methods:The data of 366 IVF cycles of women bereaved of their only child in the Reproductive Center of Northwest Women’s and Children’s Hospital from December 2013 to March 2019 were retrospectively analyzed.According to the different transplantation cycles,they were divided into two groups:fresh cycle group(n=114),FET cycle group(n=252).The baseline data and pregnancy outcomes of the two groups were compared,and a multivariate regression model was constructed to analyze the influencing factors.The pregnancy outcomes of the two groups were also analyzed by age stratification(<35 years,35-39 years,40-44 years,≥45 years).Results:The male and female age was significantly higher,and the number of good-quality embryo transferred was significantly lower in the FET cycle group compared with the fresh cycle group(P<0.05).The biochemical pregnancy rate(33.33%vs.24.60%),clinical pregnancy rate(CPR)(27.19%vs.20.63%)and implantation rate(16.84%vs.12.78%)in the fresh cycle group were higher than the FET cycle group,but there was no significant difference(P>0.05).The early pregnancy loss rate(21.05%vs.33.87%)was slightly lower than that of the FET cycle group(P>0.05).The live birth rate(LBR)of FET cycle group was significantly lower than that of fresh cycle group(12.30%vs.20.18%,P<0.05).The CPR(57.89%vs.32.35%)and LBR(47.37%vs.25.81%)of 35-39 years old group in fresh cycle group were slightly higher than in FET cycle group(P>0.05),and the differences of CPR and LBR were not significant in different age stratification groups between the fresh cycle group and FET cycle group(P>0.05).Logistic regression analysis with LBR as the dependent variable demonstrated that only maternal age was the independent influencing factor for LBR(OR=0.859,95%CI:0.750-0.983,P=0.027).Conclusions:The fresh embryo transfer cycle is more likely to have a better pregnancy outcome than the FET cycle in IVF-ET for women bereaved of the only child.However,further prospective studies are needed to validate the results.