卵裂期胚胎与囊胚移植的妊娠结局和围产期结局的比较

Comparison of pregnancy and perinatal outcomes between cleavage-stage embryo transfer and blastocyst-stage embryo transfer

目的比较卵裂期胚胎和囊胚移植的妊娠结局和围产期结局, 探讨不孕患者胚胎移植的最佳策略。方法本回顾性队列研究分析了2021年1月至2022年12月期间就诊于山西医科大学第五临床医学院、第一临床医学院和晋中婴泰妇产医院生殖医学科接受体外受精/卵胞质内单精子注射的患者资料, 分为卵裂期胚胎移植组(记为D3组, n=2 827)和囊胚移植组(记为D5组, n=1 253)。主要观察指标为大于胎龄儿(large for gestational age, LGA)、早产, 次要观察指标为多胎妊娠、分娩孕周、新生儿性别和体质量等。采用单因素及多因素二元logistic回归统计分析移植胚胎类型与不良结局的相关性。结果 D5组的临床妊娠率[64.5%(808/1 253)]、活产率[55.5%(696/1 253)]、种植率[46.0%(1 026/2 230)]、多胎妊娠率[22.6%(183/808)]、男婴占比[58.6%(515/879)]、单胎LGA率[19.8%(103/520)]和单胎早产率[21.7%(113/520)]比D3组显著升高[54.3%(1 535/2 827), P<0.001;48.2%(1 362/2 827), P<0.001;36.7%(1 962/5 346), P<0.001;19.0%(291/1 535), P=0.026;49.7%(822/1 653), P=0.001;7.5%(80/1 071), P<0.001;17.2%(184/1 071), P=0.029]。D5组在冷冻周期中的单胎LGA率[24.8%(72/290)]和新鲜周期中的单胎LGA率[13.5%(31/230)]均较D3组[8.8%(36/409), P<0.001;6.6%(44/662), P=0.002]显著升高。D5组男婴发生LGA[24.8%(82/330)]和女婴发生LGA[11.1%(21/190)]的风险均显著高于D3组[9.1%(54/592), aOR=2.95, 95%CI:2.01~4.33, P<0.001;5.4%(26/479), aOR=2.04, 95%CI:1.10~3.77, P=0.024]。结论囊胚移植的LGA和早产的发生风险高于卵裂期胚胎移植, 临床实践中应结合患者自身条件及胚胎情况选择胚胎移植方式。

Objective To compare the pregnancy and perinatal outcomes following cleavage-stage embryo transfer and blastocyst-stage embryo transfer,and to explore the best strategy of embryo transfer for infertile patients.Methods In this retrospective cohort study,data of patients who underwent in vitro fertilization/intracytoplasmic sperm injection from January 2021 to December 2022 in Reproductive Medicine Department of the Fifth Hospital and the First Hospital of Shanxi Medical University and Jinzhong Yingtai Women's and Children's Hospital were collected.Patients were divided into cleavage-stage embryo transfer group(named D3 group,n=2827)and blastocyst-stage embryo transfer group(named D5 group,n=1253).The main observation indicators were large for gestational age(LGA)and preterm birth(PTB).The secondary observation indicators were multiple pregnancy,gestational age,birth weight and newborn gender.Univariate and multivariate logistic regression were applied to analyze the correlation between embryo transfer type and adverse outcomes.Results Clinical pregnancy rate[64.5%(808/1253)],live birth rate[55.5%(696/1253)],implantation rate[46.0%(1026/2230)],multiple pregnancy rate[22.6%(183/808)],male newborn rate[58.6%(515/879)],single LGA rate[19.8%(103/520)]and single PTB rate[21.7%(113/520)]in D5 group were significantly higher than those in D3 group[54.3%(1535/2827),P<0.001;48.2%(1362/2827),P<0.001;36.7%(1962/5346),P<0.001;19.0%(291/1535),P=0.026;49.7%(822/1653),P=0.001;7.5%(80/1071),P<0.001;17.2%(184/1071),P=0.029].LGA rate[24.8%(72/290)]in the single frozen-embryo transfer and LGA rate[13.5%(31/230)]in the single fresh-embryo transfer of D5 group were significantly higher than those of D3 group[8.8%(36/409),P<0.001;6.6%(44/662),P=0.002].LGA in male newborns[24.8%(82/330)]and female newborns[11.1%(21/190)]of D5 group were significantly higher than those of D3 group[9.1%(54/592),aOR=2.95,95%CI:2.01-4.33,P<0.001;5.4%(26/479),aOR=2.04,95%CI:1.10-3.77,P=0.024].Conclusion The risk of LGA and premature birth in blastocyst-stage embryo transfer is higher than that in cleavage-stage embryo transfer.In clinical practice,embryo transfer methods should be selected based on the condition of patient and embryo.