冻融胚胎移植活产结局的相关因素分析

Analysis of factors affecting live birth outcome of frozen-thawed embryo transfer cycle

目的分析冻融胚胎移植(FET)周期活产结局的相关因素。方法以2017年1月至2020年3月广东省中医院生殖医学中心563对夫妻为研究对象,共获取736个FET周期,分析其活产结局,比较活产组和非活产组患者的妊娠结局、妊娠并发症和胚胎情况,通过多因素logistic回归模型评估15个候选因素与活产结局的关系,以确定FET活产的独立相关因素。结果纳入患者的男性取精年龄为(33±5)岁,女性取卵年龄为(31±4)岁,女性移植年龄为(32±4)岁,不孕年限为(3.5±2.6)年。736个FET周期中有333个(45.2%)活产周期,403个(54.8%)非活产周期。活产组中发生妊娠期并发症者49例(14.7%)。活产组女性移植年龄、女性取卵年龄及男性取精年龄均小于非活产组[(31±4)岁比(32±4)岁,(30±4)岁比(32±4)岁,(33±4)岁比(34±5)岁],活产组不孕年限较非活产组短[(3.2±2.2)年比(3.6±2.8)年],活产组原发性不孕的患者比例较非活产组高[(63.1%,210例)比(49.6%,200例)],以上差异均有统计学意义(均P<0.05)。多因素分析显示,女性移植年龄[OR值(95%CI)为0.50(0.27~0.92),P=0.026]、不孕类型[OR值(95%CI)为0.62(0.43~0.88),P=0.008]、移植优胚个数[OR值(95%CI)为1.60(1.11~2.31),P=0.012]以及移植胚胎类型[OR值(95%CI)为2.43(1.46~4.01),P=0.001]是FET活产的相关因素。结论女性移植年龄、不孕类型、移植优胚数、移植胚胎类型是FET活产结局的相关因素。

Objective To analyze the related factors affecting the success of frozen-thawed embryo transfer(FET).Methods A total of 563 couples treated in the Reproductive Medicine Center of Guangdong Hospital of Traditional Chinese Medicine from January 2017 to March 2020 were selected as subjects.A total of 736 FET cycles were included to analyze the live birth outcomes of FET.Pregnancy outcomes,pregnancy complications and embryo status of patients between the live birth group and the non-live birth group were compared.A multivariate logistic regression model was used to evaluate the association between the 15 candidate factors and live birth outcomes for identifying independent factors associated with the live birth outcomes of the FET.Results Among the enrolled subjects,the men were(33±5)years old at sperm extraction while the women were(31±4)years old at ovum pick-up(OPU)and(32±4)years old at embryo transfer(ET)and their infertility duration were(3.5±2.6)years.There were 333(45.2%)live birth cycles and 403(54.8%)non-live birth cycles in the 736 FET cycles.Pregnancy complications occurred in 49 cases(14.7%)of the live birth group.The age of the women at ET((31±4)vs(32±4)years),the age of the women at OPU((30±4)vs(32±4)years)and the age of the men at sperm extraction((33±4)vs(34±5)years)in the live birth group were all lower than those in the non-live birth group.The infertility duration was shorter((3.2±2.2)vs(3.6±2.8)years),and the proportion of primary infertility was higher((63.1%,210 cases)vs(49.6%,200 cases))in the live birth group(P<0.05)than those in the non-live birth group.Multivariate logistic regression analyses showed that the age of woman at ET(OR(95%CI):0.50(0.27-0.92),P=0.026),the types of infertility(0.62(0.43-0.88),P=0.008),the numbers of optimal embryos transferred(1.60(1.11-2.31),P=0.012),and the types of embryos transferred(2.43(1.46-4.01),P=0.001)were statistically significant related factors for live birth outcome of FET.Conclusion The age of the woman at ET,the types of infertility,the numbers of optimal embryos transferred and the types of embryos transferred are associated factors for the outcomes of live birth after FET.