海拔3650米西藏地区体外受精新鲜周期和冻融周期胚胎移植后临床结局的分析

Analysis of clinical outcomes of fresh and frozen-thawed embryos transfer after IVF/ICSI at altitude 3650 meters in Tibet

目的分析海拔3650米的西藏地区行IVF/ICSI-ET助孕技术的临床妊娠结局。方法回顾性分析在西藏阜康妇女儿童医院生殖中心行IVF/ICSI-ET治疗的193例不孕症患者的303个治疗周期。根据女方患者年龄分为≤35岁组(n=238)和>35岁组(n=65),每个年龄段又根据移植胚胎类型分为新鲜周期组和冻融周期组,分析比较各组间的基本情况和妊娠结局。结果≤35岁组中的新鲜周期组与冻融周期组相比较,临床妊娠率(36.92%vs.49.71%)、种植率(30.65%vs.39.26%)、流产率(12.50%vs.17.44%)、活产率(32.31%vs.41.04%)、异位妊娠率(4.17%vs.1.16%)以及多胎率(54.17%vs.43.02%)均无显著差异(P>0.05);>35岁组中的新鲜周期组与冻融周期组相比较,临床妊娠率(23.08%vs.40.38%)、种植率(16.00%vs.27.17%)、流产率(33.33%vs.19.05%)、活产率(15.38%vs.23.08%)、异位妊娠率(0.00%vs.0.00%)以及多胎率(33.33%vs.23.81%)亦均无显著差异(P>0.05)。新鲜周期组中≤35岁与>35岁相比较,临床妊娠率(36.92%vs.23.08%)、种植率(30.65%vs.16.00%)、活产率(32.31%vs.15.38%)、流产率(12.50%vs.33.33%)均无显著差异(P>0.05);冻融周期组中≤35岁与>35岁相比较,种植率(39.26%vs.27.17%)、活产率(41.04%vs.23.08%)均显著增高(P<0.05),而临床妊娠率(49.71%vs.40.38%)、流产率(17.44%vs.19.05%)均无显著差异(P>0.05)。结论海拔3650米西藏地区开展IVF-ET助孕技术可以获得较好的临床结局,女方年龄依然是影响IVF/ICSI-ET技术活产率的重要因素。

Objective:To analyze the clinical outcomes of IVF/ICSI-ET at high altitude(3650 meters)in Tibet.Methods:The data of 193 patients(303 IVF/ICSI cycles)treated in the Reproductive Center of Xizang Fukang Hospital for Women and Child were retrospectively analyzed.The patients were divided into two groups according to female age:≤35 and>35 years old group.Each age group was subdivided into two groups according to the type of embryo transfer:fresh embryo group and frozen-thawed embryo group.The general characteristic and clinical outcome were compared among the groups.Results:The clinical pregnancy rate(36.92%vs.49.71%),implantation rate(30.65%vs.39.26%),abortion rate(12.50%vs.17.44%),live birth rate(32.31%vs.41.04%),ectopic pregnancy rate(4.17%vs.1.16%)and multiple pregnancy rate(54.17%vs.43.02%)in fresh embryo group were not significantly different with frozen-thawed embryo group in patients aged≤35 years(P>0.05).The clinical pregnancy rate(23.08%vs.40.38%),implantation rate(16.00%vs.27.17%),abortion rate(33.33%vs.19.05%),live birth rate(15.38%vs.23.08%),ectopic pregnancy rate(0.00%vs.0.00%)and multiple pregnancy rate(33.33%vs.28.81%)in fresh embryo group were also not significantly different with frozen-thawed embryo group in patients aged>35 years(P>0.05).The clinical pregnancy rate(36.92%vs.23.08%),implantation rate(30.65%vs.16.00%),live birth rate(32.31%vs.15.38%),abortion rate(12.50%vs.33.33%)in≤35 years old group were not significantly different with in>35 years old group in fresh embryo transfer cycles(P>0.05).The implantation rate(39.26%vs.27.17%)and live birth rate(41.04%vs.23.08%)in≤35 years old group were significantly higher than those in>35 years old group in frozen-thawed embryo transfer cycles(P<0.05),but the clinical pregnancy rate(49.71%vs.40.38%)and abortion rate(17.44%vs.19.05%)in≤35 years old group were not significantly different with those in>35 years old group in frozen-thawed embryo transfer cycles(P>0.05).Conclusions:The IVF/ICSI-ET technique carried out at altitude 3650 meters in Tibet can achieve a good clinical outcome,and female age is still an important factor affecting the live birth rate of IVF/ICSI-ET.