新鲜周期单囊胚移植与双囊胚移植患者的妊娠结局比较

Comparison of clinical pregnancy outcomes between single blastocyst transfer and double blastocysts transfer in fresh embryo transfer cycles

目的比较新鲜周期IVF/ICSI-ET中单囊胚移植(SBT)与双囊胚移植(DBT)患者的妊娠结局。方法回顾性分析2015年1月至2018年7月期间在深圳中山泌尿外科医院通过辅助生殖助孕行新鲜周期囊胚移植的1176例患者的临床资料,根据其移植的囊胚个数不同分为SBT组(n=500)和DBT组(n=676)。比较两组患者的妊娠结局,并采用二元Logistic回归分析妊娠结局的影响因素。结果两组患者的一般情况中,与DBT组相比,SBT组的基础E 2水平[(40.52±29.60)pmol/L vs.(36.96±19.39)pmol/L]显著上升,原发不孕比例(44.6%vs.54.7%)显著下降(P<0.05);而年龄、体重指数(BMI)等两组间无显著性差异(P>0.05)。两组的促排卵情况中,与DBT组相比,SBT组的Gn天数[(9.66±1.93)vs.(9.41±1.62)d]显著增加,而优胚率(67.0%vs.69.0%)、囊胚形成率(61.4%vs.66.0%)显著下降(P<0.05)。两组的妊娠结局比较显示,SBT组的临床妊娠率(65.4%vs.79.4%)、活产率(83.8%vs.89.8%)显著低于DBT组,晚期流产率(1.5%vs.4.1%)、多胎率(2.6%vs.51.9%)及早产率(8.8%vs.33.0%)亦显著低于DBT组(P<0.05)。Logistic回归分析表明,移植囊胚数能够独立影响活产率(P=0.029)及早产率(P=0.0001)。结论DBT能够提高活产率,但大大增加了早产率、多胎率及晚期流产率,因此,不孕患者的移植策略还需临床医生结合患者具体情况择优而选。

Objective:To compare the clinical pregnancy outcomes between single blastocyst transfer(SBT)and double blastocysts transfer(DBT)in fresh IVF/ICSI-ET cycles.Methods:The clinical data of 1176 patients undergone fresh embryo transfer cycles in Shenzhen Zhongshan Urology Hospital from January 2015 to July 2018 were retrospectively analyzed.According to the number of blastocysts transferred,the patients were divided into two groups:SBT group(n=500)and DBT group(n=676).The clinical pregnancy outcomes of the two groups were compared.Results:In general conditions,the basic E 2 level in SBT group was significantly increased[(40.52±29.60)pmol/L vs.(36.96±19.39)pmol/L],and the primary infertility proportion(44.6%vs.54.7%)was significantly decreased compared with DBT group(P<0.05).There were no significant differences in age and BMI between the two groups(P>0.05).In ovulation induction status,the days of Gn used[(9.66±1.93)vs.(9.41±1.62)]was significantly increased,while the high-quality embryo rate(67.0%vs.69.0%)and the blastocyst formation rate(61.4%vs.66.0%)were significantly decreased in SBT group compared with DBT group(P<0.05).Comparison of pregnancy outcomes between the two groups showed that the clinical pregnancy rate(65.4%vs.79.4%)and live birth rate(83.8%vs.89.8%)in SBT group were significantly lower than those in DBT group,while the late abortion rate(1.5%vs.4.1%),multiple pregnancy rate(2.6%vs.51.9%)and preterm birth rate(8.8%vs.33.0%)were also significantly decreased(P<0.05).Logistic regression analysis showed that the number of blastocysts transplanted independently affected the live birth rate(P=0.029)and the premature birth rate(P=0.0001).Conclusions:Double blastocysts transfer can slightly improve the live birth rate,but greatly increases preterm birth rate,multiple birth rate,and late abortion rate.Therefore,clinician’s choice of the transplantation strategy for infertile patients should be based on the patient’s specific conditions.