新鲜和冻融胚胎移植中异位妊娠风险的分析

Analysis on the risks of ectopic pregnancy in fresh and frozenthawed human embryos transplantation

目的比较新鲜卵裂胚移植、新鲜囊胚移植、冻融卵裂胚移植和冻融囊胚移植妇女异位妊娠发生情况,及不同移植胚胎数目下四组的异位妊娠发生风险分析。方法回顾性分析2014年1月1日~2019年9月1日在本院生殖医学中心行体外受精/卵胞浆内单精子注射-胚胎移植术(IVF/ICSI-ET)后获得宫内妊娠或异位妊娠的4428个胚胎移植周期。根据胚胎类型和移植类型分为四组:新鲜卵裂胚组(A1组)、新鲜囊胚组(A2组)、冻融卵裂胚组(B1组)和冻融囊胚组(B2组)。比较四组患者的异位妊娠发生率。多因素Logistic回归分析比较四组异位妊娠风险差异。结果A1组的异位妊娠率为2.6%(35/1321),A2组为3.0%(3/99),B1组为2.8%(39/1406),B2组为1.1%(18/1602),B2组的异位妊娠率低于其余三组,差异有统计学意义(P<0.05)。多因素Logistic回归分析发现,与卵裂胚移植组(A1组和B1组)比较,B2组异位妊娠风险显著性降低。结论冻融囊胚移植后异位妊娠发生率低于新鲜周期移植和冻融卵裂胚移植。

Objective To compare the incidences of women ectopic pregnancy in fresh cleavage embryo transplantation,fresh blastocyst transplantation,frozen-thawed cleavage embryo transplantation and frozen-thawed blastocyst transplantation,and to analyze the risks of ectopic pregnancy in the four groups with different numbers of transplanted embryos.Methods From January 1st,2014 to September 1st,2019,4428 embryo transplantation cycles of intrauterine pregnancy or ectopic pregnancy after in vitro fertilization/intracytoplasmic sperm injectionembryo transplantation(IVF/ICSI-ET)admitted to the Reproductive Medicine Center of our hospital were analyzed retrospectively.According to the embryo types and transplantation types,they were divided into four groups:the fresh cleavage embryo group(A1),the fresh blastocyst group(A2),the frozen-thawed cleavage embryo group(B1)and the frozen-thawed blastocyst group(B2).The incidences of ectopic pregnancy in the four groups were compared.Meanwhile,the multiple Logistic regression analysis was used to compare the risk differences of ectopic pregnancy in the four groups.Results The ectopic pregnancy rate was 2.6%in A1 group(35/1321),3.0%in A2 group(3/99),2.8%in B1 group(39/1406),1.1%in B2 group(18/1602),and the ectopic pregnancy rate in B2 group was lower than the other three groups,with statistically significant differences(P<0.05).It was shown by multiple Logistic regression analysis that the risk of ectopic pregnancy in B2 group was significantly reduced when compared with the cleavage embryo transplantation groups(A1 and B1).Conclusion The incidence of ectopic pregnancy after frozen-thawed blastocyst transplantation is lower than those of fresh cycle transplantations and frozen-thawed cleavage embryo transplantation.