胚胎移植后早期自然流产伴绒毛染色体异常患者再次移植临床结局分析

Analysis of clinical outcomes after embryo transfer again in IVF-ET/FET patients with previous spontaneous abortion in early pregnancy and fetal chromosomal abnormalities

目的分析体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)和冻融胚胎移植(frozen-thawed embryo transfer,FET)妊娠后染色体异常患者再次胚胎移植的临床结局。方法回顾性病例对照研究分析2015年7月至2019年12月期间于烟台毓璜顶医院生殖医学科行IVF-ET/FET助孕妊娠后172例早期自然流产伴绒毛染色体异常患者(绒毛染色体异常组),及127例同期早期自然流产伴绒毛染色体正常患者(绒毛染色体正常组)的临床资料。对上述患者进行针对年龄、抗苗勒管激素、基础卵泡刺激素的倾向性评分匹配(propensity score matching,PSM),再比较两组患者胚胎移植后临床结局。结果PSM前,绒毛染色体异常组患者年龄[34.0(30.0,38.0)岁]大于绒毛染色体正常组患者[32.0(30.0,36.0)岁,P=0.015]。两组患者再次移植后,临床妊娠率、早期流产率、近似活产率、累积活产率比较,差异均无统计学意义(均P>0.05)。PSM后两组患者临床妊娠率、早期流产率、近似活产率、累积活产率比较,差异均无统计学意义(均P>0.05)。结论绒毛染色体异常患者再次胚胎移植后可达到与绒毛染色体正常患者相似的临床结局,建议患者尽早继续助孕治疗。

Objective To investigate clinical outcomes after embryo transfer again in in vitro fertilization and embryo transfer/frozen-thawed embryo transfer(IVF-ET/FET)patients with previous fetal chromosomal abnormalities.Methods In this retrospective case-control study,data of patients who received IVF-ET/FET treatment at the Department of Reproductive Medicine,Yantai Yuhuangding Hospital between July 2015 and December 2019 and had embryo chromosomes tested after spontaneous abortion were analyzed.Among 299 patients,172 cases were found to have fetal chromosomal abnormalities(abnormal group)and 127 cases were found to have normal results(normal group).We matched the above patients cycles with age,anti-Müllerian hormone and basal follicle-stimulating hormone using propensity score matching(PSM).Clinical data were analyzed again after PSM.Results Before PSM,patients in abnormal group[34.0(30.0,38.0)years]were significantly older than those in normal group[32.0(30.0,36.0)years,P=0.015].There were no statistically significant differences in clinical pregnancy rate,early miscarriage rate,approximate live birth rate and cumulative live birth rate(all P>0.05).After PSM matching,there were also no statistically significant differences in clinical pregnancy rate,early miscarriage rate,approximate live birth rate and cumulative live birth rate(all P>0.05).Conclusion Patients with fetal chromosomal abnormalities can achieve similar clinical outcomes after embryo transfer again.Therefore IVF-ET or FET is recommended as early as possible.