整倍体囊胚发育天数对母婴结局的影响

Effect of blastulation time on maternal and neonatal outcomes following single euploid blastocyst transfer

目的:探究整倍体囊胚的发育天数是否对孕产期并发症及新生儿结局存在影响。方法:回顾性队列研究分析2017年10月至2021年6月期间在上海交通大学医学院附属仁济医院生殖医学中心进行胚胎植入前非整倍体遗传学检测(preimplantation genetic testing for aneuploidies,PGT-A),移植整倍体单囊胚并获得单胎活产的893例患者的临床资料。按照移植囊胚的发育天数,将患者分为第5天(day 5,D5)组(n=768)及第6天(day 6,D6)组(n=125)。采用2∶1倾向性评分匹配(propensity score matching,PSM)方法对两组的女方年龄、体质量指数(body mass index,BMI)、不孕年限进行匹配,匹配后纳入D5组250例,D6组125例。比较两组患者的基线特征、取卵和移植周期特征、孕产期并发症及新生儿结局。同时,根据女方年龄将患者进一步分为<35岁组和≥35岁组进行分层分析。结果:PSM后D5组与D6组女方年龄、BMI、不孕年限、助孕指征等基线特征差异均无统计学意义(均P>0.05)。两组获卵数和双原核(two pronuclei,2PN)数差异均无统计学意义(均P>0.05),但D5组冷冻胚胎数[5.00(3.00,7.00)个]较D6组多[3.00(2.00,5.00)个,P<0.001]。D5组移植优质胚胎的周期占比[81.6%(204/250)]较D6组高[40.0%(50/125),P<0.001]。两组的妊娠期糖尿病、妊娠期高血压疾病、妊娠期甲状腺疾病、早产、未足月胎膜早破、胎盘相关疾病及产后出血的发生率差异均无统计学意义(均P>0.05)。两组的新生儿出生体质量、胎龄、性别、低出生体质量、巨大儿、小于胎龄儿、大于胎龄儿及出生缺陷发生率等差异均无统计学意义(均P>0.05)。根据年龄的分层分析显示,不同年龄层中D5组和D6组母婴结局差异均无统计学意义(均P>0.05)。结论:整倍体囊胚的发育天数对孕产期并发症及新生儿结局无显著影响。

Objective To investigate whether blastulation time would impact maternal and neonatal outcomes following single euploid blastocyst transfer.MethodsA retrospective cohort study was conducted at the Centre for Reproductive Medicine of Renji Hospital,Shanghai Jiao Tong University School of Medicine between October 2017 and June 2021.Totally 893 patients who received preimplantation genetic testing for aneuploidies(PGT-A)and delivered singleton live birth after frozen single euploid blastocyst transfer were included.Patients were divided into day 5(D5)group(n=768)and day 6(D6)group(n=125)according to timing of blastulation.Propensity score matching(PSM)with a ratio of 2∶1 was conducted to balance potential confounding factors including female age,body mass index(BMI)and infertility duration.After PSM,there were 250 patients in D5 group and 125 patients in D6 group.Basic characteristics,ovarian stimulation and embryo transfer cycle characteristics,pregnancy complications and neonatal outcomes of the two groups were compared.Furthermore,patients were divided into<35 years old group and≥35 years old group by maternal age to conduct stratified analysis.ResultsThere were no statistically significant differences in the baseline characteristics including female age,BMI,infertility duration and indication for infertility treatment between the two groups after PSM(all P>0.05).The number of oocytes retrieved and the number of two pronuclei(2PN)did not differ between the two groups(allP>0.05),while the number of embryos cryopreserved was significantly increased in D5 group than in D6 group[5.00(3.00,7.00)vs.3.00(2.00,5.00),P<0.001].The proportion of cycles transferring good-quality embryos was significantly higher in D5 group than in D6 group[81.6%(204/250)vs.40.0%(50/125),P<0.001].No significant differences were observed in the incidences of gestational diabetes,hypertensive disorders of pregnancy,thyroid diseases during pregnancy,premature preterm rupture of membranes,preterm delivery,placenta disorder and postpartum hemorrhage between the two groups(allP>0.05).The birth weight,gestational age,neonate sex,the incidences of low birth weight,macrosomia,small for gestational age,large for gestational age and birth defects did not differ as well(allP>0.05).In stratified analysis,there were no significant differences in maternal and neonatal outcomes between D5 group and D6 group for women who aged<35 years or≥35 years(allP>0.05).ConclusionTiming of blastulation in euploid blastocysts does not impact maternal and neonatal outcomes.