应用赠卵与自卵行ICSI-FET助孕的围产期结局的比较分析

Comparative analysis of perinatal outcome of intracytoplasmic sperm injection and frozen-thawed embryo transfer between donor and autologous oocytes

目的比较不孕女性应用赠卵与自卵行卵胞质内单精子注射-冻融胚胎移植(intracytoplasmic sperm injection and frozen-thawed embryo transfer,ICSI-FET)助孕治疗的围产期结局。方法回顾性队列研究分析2016年6月至2020年1月期间在郑州大学第三附属医院生殖医学中心行ICSI-FET并临床妊娠的患者的临床资料。纳入应用赠卵的73例患者(受卵组)和同期应用自卵的550例患者(自卵组),利用倾向性评分匹配(propensity score matching,PSM)对其匹配得到受卵组47例和自卵组131例,比较两组患者基线数据和围产期结局的差异,应用多因素logistic回归与线性回归分析影响其围产期结局的危险因素。结果受卵组的双侧窦卵泡计数(3.08±4.78)和基础雌二醇水平[(71.55±45.29)pmol/L]均显著低于自卵组[14.95±6.42,(132.84±74.89)pmol/L,均P<0.001]。受卵组单胎活产的新生儿出生体质量[(2916.48±537.55)g]低于自卵组[(3326.67±503.43)g],差异有统计学意义(P<0.001)。受卵组和自卵组相比,早产率[21.28%(10/47)比16.03%(21/131),P=0.416]和妊娠期高血压疾病发生率[12.77%(6/47)比7.63%(10/131),P=0.448]均有升高趋势,但差异均无统计学意义。赠卵ICSI-FET降低了单胎的新生儿出生体质量(MD=-388.225,95%CI=-625.914~-150.537,P=0.002)。结论赠卵ICSI-FET围产期结局相对安全,但其单胎活产的新生儿出生体质量低于自卵ICSI-FET。

Objective To investigate the obstetric outcomes of intracytoplasmic sperm injection and frozen-thawed embryo transfer(ICSI-FET)between donor and autologous oocytes.Methods A retrospective cohort study was conducted to analyze the clinical data of pregnant patients who underwent ICSI-FET in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from June 2016 to January 2020.Totally 73 patients with donor oocytes,and 550 patients who used autologous oocytes in the same period,and the patients were matched at 1∶3 with propensity score matching(PSM),then there were 47 patients in donor group and 131 patients in autologous group.The general conditions and obstetric outcomes were compared among donor group and autologous group.Multivariate logistic regression and linear regression were applied to analyze the factors affecting perinatal complications.Results The bilateral antral follicle count(3.08±4.78)and basal estradiol level[(71.55±45.29)pmol/L]in donor group were significantly lower than those in autologous group[14.95±6.42,(132.84±74.89)pmol/L,all P<0.001].The birth weight of singleton in donor group[(2916.48±537.55)g]was lower than that in autologous group[(3326.67±503.43)g],and there was significant difference(P<0.001).There were no significant differences in premature birth rate[21.28%(10/47)vs.16.03%(21/131),P=0.416]and incidence of hypertensive disorder complicating pregnancy[12.77%(6/47)vs.7.63%(10/131),P=0.448]between donor group and autologous group,but both of them had an increasing trend in donor group.Oocyte-donated ICSI-FET reduced the birth weight of singleton(MD=-388.225,95%CI=-625.914--150.537,P=0.002).Conclusion The perinatal outcome of oocyte-donated ICSI-FET is relatively safe,but the birth weight of singleton is lower than that of self-oocyte ICSI-FET.