多周期IVF-ET患者新鲜移植与冻融胚胎移植妊娠结局的比较

Comparison of pregnancy outcomes between fresh embryo transfer and frozen-thawed embryo transfer in patients with multiple cycles of IVF-ET

目的比较多周期IVF/ICSI-ET患者新鲜移植与第1次冻融胚胎移植(FET)的妊娠结局。方法回顾性分析2014年1月至2018年12月在我院生殖中心行2个周期以上的IVF/ICSI-ET助孕周期患者(共2155个周期)的临床资料。根据是否行新鲜周期移植分为2组:新鲜周期移植组,共1474个周期;FET组,共681个周期。比较2组患者的基本资料、促排卵实验室指标及妊娠结局,并采用Logistic回归分析活产率的影响因素。结果两组患者间原发不孕比例、体重指数(BMI)比较无显著性差异(P>0.05);FET组患者年龄、周期次数、不孕年限均显著高于新鲜周期组(P<0.05)。新鲜周期组长方案、超长方案、超短方案占比均显著大于FET组(P<0.05);FET组拮抗剂方案占比显著大于新鲜周期组(P<0.05)。新鲜周期组Gn天数、移植前末次内膜厚度、获卵数均显著大于FET组(P<0.05);FET组HCG日孕酮(P)水平显著高于新鲜周期组(P<0.05)。新鲜周期组的活产率、早产率、双胎率均略高于FET组,但尚无显著性差异(P>0.05)。行多因素Logistic回归分析结果显示,随着年龄的增加、移植前末次内膜厚度减小,活产率有下降趋势(P<0.05)。结论多周期IVF/ICSI-ET患者助孕过程中选择新鲜周期移植并不降低临床妊娠率,且可能有更好的效价比,有助于降低患者的经济和心理压力。

Objective:To compare the pregnancy outcomes between fresh embryo transfer cycle and the first cycle of frozen-thawed embryo transfer(FET)in patients with multiple cycles of IVF-ET.Methods:The clinical data of patients with more than 2 cycles of IVF/ICSI(2155 cycles in total)in the reproductive center of our hospital from January 2014 to December 2018 were retrospectively analyzed.The patients were divided into two groups according to transfer fresh embryos or not:fresh transfer group(n=1474)and FET group(n=681).The basic data,laboratory indicators of ovulation induction and pregnancy outcome were compared between the two groups,and logistic regression was used to analyze the influencing factors of live birth rate.Results:There was no significant difference in the proportion of primary infertility and body mass index(BMI)between the two groups(P>0.05).The age,number of cycles,and infertility years in the FET group were significantly higher than those in the fresh transfer group(P<0.05).The proportion of long protocol,ultra-long protocol,and ultra-short protocol of the fresh transfer group were significantly more than that of the FET group(P<0.05).The proportion of antagonist protocol in the FET group was significantly more than that of the fresh transfer group(P<0.05).The Gn days,the last endometrial thickness before transplantation,and the number of oocytes retrieved in the fresh transfer group were significantly more than those in the FET group(P<0.05).The progesterone(P)level on HCG day in the FET group was significantly higher than that in the fresh transfer group(P<0.05).The live birth rate,preterm birth rate and twin rate of the fresh transfer group were slightly higher than those of the FET group,but there was no significant difference(P>0.05).The results of multivariate logistic regression analysis showed that the last endometrial thickness was decreased before transplantation and the live birth rate had a downward trend along with the increase of age(P<0.05).Conclusions:Choosing fresh embryo transfer in the patients with multiple cycle of IVF/ICSI-ET does not reduce the clinical pregnancy rate,and may have a better cost effectiveness,which can reduce the economic and psychological pressure of patients.