高龄女性新鲜与冷冻胚胎移植后妊娠及围产结局

Pregnancy and Perinatal Outcomes After Fresh Versus Frozen Embryo Transfer Cycles in Women of Advanced Age

【目的】本研究旨在分析高龄女性自体新鲜胚胎移植与冷冻胚胎移植后的妊娠和围产结局,探讨行辅助生殖技术助孕的高龄女性鲜胚移植与冻胚移植方案有效性和安全性。【方法】回顾性队列研究分析2015年9月至2020年5月期间在中山大学附属第三医院生殖医学中心首次接受体外受精/卵胞浆内单精子注射治疗且进行首次胚胎移植≥35岁的女性患者,共纳入1622例患者的1622个胚胎移植周期,其中新鲜胚胎移植903例患者(新鲜胚胎移植组),冷冻胚胎移植719例患者(冷冻胚胎移植组),比较两组患者的基线特征、妊娠结局、妊娠期并发症发生率和围产结局。通过logistic回归分析调整混杂因素后,分析两组胚胎移植方案的妊娠结局及并发症的发生率。【结果】高龄女性患者新鲜胚胎移植临床妊娠率为40.2%,冷冻胚胎移植的临床妊娠率为36.6%,两组相比差异有统计学意义[OR 95%CI为1.66(1.323,2.078),P<0.001];两组患者的流产率[25.1%vs.33.5%,OR 95%CI为0.53(0.356,0.794),P=0.002]、活产率[29.7%vs.23.8%,OR 95%CI为1.93(1.505,2.484),P<0.001]、剖宫产率[70.5%vs.76.6%,OR 95%CI为0.60(0.362,0.987),P=0.044]、多胎妊娠率[25.1%vs.12.2%,OR 95%CI为1.89(1.114,3.190),P=0.018]、妊娠期高血压[2.2%vs.4.6%,OR 95%CI为0.35(0.128,0.947),P=0.039]差异有统计学意义。两组患者胚胎移植后异位妊娠率、早产率、妊娠期糖尿病和胎膜早破差异无统计学意义(P>0.05)。冷冻胚胎移植新生儿平均出生体质量为3133(S=612)g,高于新鲜胚胎移植新生儿平均出生体质量2977(S=609)g,差异有统计学意义(P=0.006)。进一步年龄分层分析,35-37岁患者新鲜移植临床妊娠率显著高于冷冻胚胎移植[47.8%vs.45.4%,OR 95%CI为1.68(1.176,2.391),P=0.004]差异有统计学意义。35-37岁及38-39岁患者的新鲜胚胎移植活产率高于冷冻胚胎移植[39.3%vs.32.9%,OR 95%CI为1.79(1.239,2.581),P=0.002]、[35.5%vs.30.4%,OR 95%CI为1.70(1.023,2.809),P=0.040]差异具有统计学意义。【结论】高龄女性患者新鲜胚胎移植可以获得较好的妊娠及新生儿结局,建议高龄患者在自身条件许可的情况下优先行新鲜胚胎移植,鲜胚移植也可减少胚胎移植的等待时间及改善高龄女性随着时间推移导致的不良结局。

【Objective】The objective of the present study was to com pare the pregnancy and perinatal outcomes in women of advanced age between autologous fresh ET and FET cycles.【Methods】A retrospective cohort study was conducted,which included 1622 transfer cycles of 1622 patients with≥35 years of age.Patients who received their first embryo trans⁃fer cycle(IVF/ICSI treatment)between October 2015 and May 2020 in the center of reproductive medicine of the Third Af⁃filiated Hospital of Sun Yat-sen University were included.Among them,903 patients had 903 fresh ET cycles,and 719 freeze-all patients received 719 FET cycles.The baseline characteristics,pregnancy outcomes,complication rates,and perinatal outcomes were compared between the two groups.Logistic regression was performed to adjusted for confounding factors.【Results】Women with advanced age and fresh embryo transfer had significantly higher clinical pregnancy rate[40.2%vs.36.6%,OR 95%CI:1.66(1.323,2.078),P<0.001],live birth rate[29.7%vs.23.8%,OR 95%CI:1.93(1.505,2.484),P<0.001],and multiple pregnancy rate[25.1%vs.12.2%,OR 95%CI:1.89(1.114,3.190),P=0.018]than those with FET cycles.Fresh embryo transfer had significantly decreased miscarriage rate[25.1%vs.33.5%,OR 95%CI:0.53(0.356,0.794),P=0.002],Caesarean delivery rate[70.5%vs.76.6%,OR 95%CI:0.60(0.362,0.987),P=0.044],and hypertensive disorders of pregnancy[2.2%vs.4.6%,OR 95%CI:0.35(0.128,0.947),P=0.039]than those of FET group.There were no significant differences in the rate of ectopic pregnancy,preterm delivery rate,gestation⁃al diabetes mellitus.and preterm premature rupture between the two groups(P>0.05).FET group had significantly higher mean new born birth weight[(3133±612)g vs.(2977±609)g,P=0.006].Further age-stratified analysis showed that the clinical pregnancy rate of fresh transfer was significantly higher than that of frozen embryo transfer in patients aged 35-37 years[47.8%vs.45.4%,OR 95%CI:1.68(1.176,2.391),P=0.004].The live birth rate of fresh embryo transfer in pa⁃tients aged 35-37 years and 38-39 years was higher than that of frozen embryo transfer[39.3%vs.32.9%,OR 95%CI:1.79(1.239,2.581),P=0.002],[35.5%vs.30.4%,OR 95%CI:1.70(1.023,2.809),P=0.040].【Conclusions】Patients with advanced age obtain better pregnancy and neonatal outcomes by fresh embryo transfer than by frozen embryo transfer.Patients without contraindications should preferentially choose fresh embryo transfer to improve their pregnancy outcome,reduce the waiting time for embryo transfer,and to avoid the adverse outcomes which increase over time with advanced age.