不孕症患者生育二孩冻融胚胎移植结局的影响因素分析

Factors Affecting the Outcomes of Frozen Embryo Transfer Cycles in Women Returning to FET Treatment for A Second ART-Conceived Child

目的:探讨不孕症患者生育二孩行冻融胚胎移植(FET)的各种影响因素。方法:回顾性分析南方医科大学南方医院妇产科生殖医学中心2011年1月至2019年3月通过胚胎移植妊娠分娩1个健康孩子后再次行FET的不孕症患者235例的临床资料(均为在同一取卵周期中,且在本次FET周期中均移植2枚优质卵裂期胚胎),采用单因素及Logistic回归分析影响FET临床结局(种植率、临床妊娠率、早期流产率、活产率)的相关因素。结果:①移植日子宫内膜厚度≥8 mm患者的种植率及活产率显著高于内膜厚度<8 mm的患者(P<0.05);前次分娩方式中剖宫产组患者的胚胎种植率、临床妊娠率及活产率显著低于经阴道分娩组患者(P<0.05);移植2个8细胞胚胎组患者的种植率显著高于移植胚胎中不含八细胞胚胎组患者(P<0.05)。②Logistic回归分析结果显示:移植2个8细胞胚胎会显著提高临床妊娠率(OR>1,P<0.05),前次分娩为剖宫产会显著降低临床妊娠率(OR<1,P<0.05)。③在移植日内膜厚度<8 mm的患者中,前次妊娠经阴道分娩组患者的种植率、临床妊娠率和活产率显著高于剖宫产组患者(P<0.05),而在移植日内膜厚度≥8 mm组中,各种临床结局差异无统计学意义(P>0.05)。结论:前次分娩方式为剖宫产及当本次移植日内膜厚度不足8 mm时其临床结局不佳。移植胚胎中八细胞胚胎个数和分娩方式是不孕症患者生育二孩FET临床妊娠结局的显著影响因素。

Objective:To evaluate the influence factors on the clinical outcomes of freeze-thaw embryo transfer(FET)in infertile patients seeking for a second child.Methods:A retrospective analysis was performed in 235 infertile patientswho returned to FET treatment for a second ART-conceived child after a successful embryo transfer cycle in Reproductive Center of Nanfang Hospital, Southern Medical University from January 2011 to March 2019(Two high quality cleavage stage embryos from the same ovarian hyperstimulationcycle were transplanted in this FET cycle).Univariate and Multivariate logistic regression analysis was used to analyze the factors influencing the clinical outcome of FET implantation rate, clinical pregnancy rate, early miscarriage rate and live birth rate.Results:①The implantation rate and live birth rate of patients with endometrial thickness≥8 mm on transplantation day were significantly higher than those patients with endometrial thickness<8 mm(P<0.05);Implantation rate, clinical pregnancy rate and live birth rate in the cesarean section group were significantly lower than those in the vaginal delivery group(P<0.05).The implantation rate of two eight-cell embryos group was significantly higher than that of non-eight-cell embryos group(P<0.05).②Logistic regression analysis showed that the clinical pregnancy rate was significantly increased when the number of blastomeres containing eight-cell embryos was 2(OR>1,P<0.05),and was significantly decreased when the previous delivery was cesarean section(OR<1,P<0.05).③Among patients with endometrial thickness<8 mm on transplantation day in FET cycle, the implantation rate, clinical pregnancy rate and live birth rate in the vaginal delivery group were significantly higher than those in the cesarean section group.However, there was no significant difference in clinical outcomes between the vaginal delivery group and the cesarean section group when the endometrial thickness≥8 mm in both groups on transplantation day(P>0.05).Conclusions:The endometrial thickness<8 mm on the transplantation daywould have a negative impact on the clinical outcome of the patients who experienced cesarean section during the last pregnancy.The number of eight-cell embryos and the mode of delivery in frozen-thawed embryo transfer are significant factors affecting the clinical outcomes in infertile patients who returned to FET treatment for a second ART-conceived child.