单卵裂期胚胎移植临床妊娠率影响因素分析

Analysis of influencing factors on clinical pregnancy rate of single cleavage embryo transfer

目的探讨单卵裂期胚胎移植周期中影响临床妊娠的相关因素。方法采用回顾性队列研究收集河南省人民医院生殖医学中心2017年1月至2021年10月期间行单卵裂期胚胎移植的2764例患者的临床资料与周期结局,采用单因素与多因素logistic回归探讨单卵裂期胚胎移植临床妊娠的独立影响因素。结果多因素logistic回归分析显示年龄、促排卵方案、窦卵泡数、胚胎细胞数、碎片率、内膜厚度、选择性移植是临床妊娠率的独立影响因素(均P<0.05),其中卵裂期胚胎细胞数对临床妊娠率的影响(OR=2.92,95%CI:1.58~5.39)大于碎片率(OR=0.73,95%CI:0.55~0.98)。进一步分层分析结果显示,<35岁患者不论移植胚胎碎片率是否>10%,8-细胞胚胎的临床妊娠率均显著增加(OR=4.78,95%CI:3.06~7.47;OR=3.53,95%CI:1.85~6.76);而≥35岁患者,当移植胚胎碎片率≤10%,8-细胞胚胎较4~6-细胞的临床妊娠率显著增加(OR=3.58,95%CI:1.64~7.84)。结论胚胎细胞数、碎片率是影响年轻患者单卵裂期胚胎移植临床妊娠率的主要因素,其中前者与临床妊娠率的关联强度更大。移植胚胎的细胞数减少与临床妊娠率降低相关,移植时应首选8-细胞、碎片率≤10%的卵裂期胚胎。

Objective To explore the influencing factors of clinical pregnancy rate after single cleavage embryo transfer.Methods A total of 2764 patients who underwent single cleavage embryo transfer in the Reproductive Medicine Center of Henan Provincial People's Hospital from January 2017 to October 2021 were included in a retrospective cohort study,The clinical data and cycle outcomes were analyzed by using univariate and multivariate logistic regression to explore the independent influencing factors of clinical pregnancy.Results Multivariate logistic regression analysis showed that age,ovulation stimulation protocol,antral follicle number,blastomere number,fragment ratio,endometrial thickness,elective single embryo transfer were independent influencing factors of clinical pregnancy rate(all P<0.05).The effect of blastomere number on clinical pregnancy rate(OR=2.92,95%CI:1.58-5.39)was stronger than that of fragment ratio(OR=0.73,95%CI:0.55-0.98).The results of further stratified analysis showed that when the number of embryo cells was 8,the clinical pregnancy rate of patients less than 35 years old was significantly increased regardless of whether the embryo fragment ratio was more than 10%or not(OR=4.78,95%CI:3.06-7.47;OR=3.53,95%CI:1.85-6.76),while in patients≥35 years old,when the fragment ratio of transferred embryos was less than 10%,the clinical pregnancy rate of 8-cell embryos was significantly higher than that of 4-6-cell embryos(OR=3.58,95%CI:1.64-7.84).Conclusion The blastomere number and fragment ratio are the main influencing factors of the clinical pregnancy rate of single cleavage embryo transfer in young patients and the former has a stronger correlation with the clinical pregnancy rate.The decrease of blastomere number of transferred embryos is related to the decrease of clinical pregnancy rate.Cleavage embryos with 8 cells and fragment ratio less than 10% should be preferred for transfer.