新鲜周期第4天不同移植方案妊娠结局和母婴结局比较

Comparison of clinical outcomes and maternal and fetal outcomes between different transplantation schemes on day 4 in fresh cycle

目的探讨新鲜周期第4天不同移植方案对临床结局及母婴结局的影响。方法回顾性队列研究分析2019年1月至2021年12月期间于邢台不孕不育专科医院生殖医学中心行体外受精(in vitro fertilization,IVF)和卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)的745个周期的临床资料。所有周期均在受精后第4天移植1~2枚胚胎,根据不同胚胎移植方案分为5组:部分融合1枚组(A组,n=17)、部分融合2枚组(B组,n=236)、完全融合以上1枚组(C组,n=241)、部分融合+完全融合以上组(D组,n=72)和完全融合以上2枚组(E组,n=179),比较不同移植方案对临床结局和母婴结局的影响。结果不同组间的双原核(two pronuclei,2PN)受精率、2PN卵裂率、内膜厚度、单卵双胎率、手术减胎率、流产率、死亡率、剖宫产率、男婴/女婴比例等差异均无统计学意义(均P>0.05)。D组和E组临床妊娠率[83.33%(60/72)、72.63%(130/179)]显著高于B组[59.32%(140/236),P<0.001,P=0.005],E组活产率[65.36%(117/179)]显著高于B组[50.00%(118/236),P=0.002],C、D、E组种植率[64.73%(156/241)、59.72%(86/144)、54.19%(194/358)]显著高于B组[39.83%(188/472),均P<0.001],D组和E组的多胎率[43.33%(26/60),49.23%(64/130)]和早产率[23.33%(14/60),26.15%(34/130)]均显著高于C组[0%,均P<0.001;7.69%(12/156),P=0.002,P<0.001],E组分娩孕周[38.0(36.0,39.0)周]显著低于C组[39.0(38.0,39.3)周,P<0.001]。与移植1枚组(A组和C组)比较,移植2枚胚胎组(B、D、E组)出生体质量显著降低(P<0.001),D组和E组的低出生体质量儿率[20.90%(14/67),28.40%(48/169)]显著高于C组[3.85%(5/130),P<0.001]。logistic回归分析显示,调整混杂因素后,C组临床妊娠率显著高于A组(OR=0.353,95%CI:0.125~0.997,P=0.049);E组的活产率显著高于C组(OR=1.842,95%CI:1.172~2.895,P=0.008);B、D、E组的早产率均显著高于C组(OR=2.546,95%CI:1.079~6.005,P=0.033;OR=6.737,95%CI:2.566~17.689,P<0.001;OR=5.863,95%CI:2.494~13.785,P<0.001)。结论新鲜周期第4天达到完全融合以上胚胎的妊娠率和活产率显著高于部分融合胚胎,临床工作中推荐优选完全融合及以上胚胎,其次选择部分融合胚胎,行单胚胎移植,以在获得最佳妊娠结局的同时降低多胎率、早产率及低出生体质量儿率。

Objective To explore the effect of different transplantation schemes on the clinical outcomes and maternal and fetal outcomes of fresh cycle on day 4.MethodsThe clinical data of 745 cycles of in vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI)in Reproductive Medicine Center of Xingtai Infertility Specialist Hospitals from January 2019 to December 2021 were analyzed retrospectively.In all cycles,1-2 embryos were transferred on day 4 after fertilization.According to different embryo transfer schemes,they were divided into five groups:one partial compaction embryo group(group A,n=17),two partial compaction embryos group(group B,n=236),one full compaction above embryo group(group C,n=241),partial compaction+full compaction above group(group D,n=72),and two full compaction above embryos group(group E,n=179),the effects of different transfer schemes on clinical outcomes and maternal and fetal outcomes were compared.ResultsThere were no significant differences in two pronuclei(2PN)fertilization rate,2PN cleavage rate,endometrial thickness,monozygotic twins rate,surgical reduction rate,abortion rate,stillbirth rate,cesarean section rate,male infant/female infant ratio among the five groups(all P>0.05).The clinical pregnancy rate in groups D and E[83.33%(60/72),72.63%(130/179)]was significantly higher than that in group B[59.32%(140/236),P<0.001,P=0.005].The live birth rate of group E[65.36%(117/179)]was significantly higher than that of group B[50.00%(118/236),P=0.002].The implantation rate of groups C,D and E[64.73%(156/241),59.72%(86/144),54.19%(194/358)]was significantly higher than that of group B[39.83%(188/472),all P<0.001].The multiple birth rate[43.33%(26/60),49.23%(64/130)]and the premature delivery rate[23.33%(14/60),26.15%(34/130)]in groups D and E were significantly higher than those in group C[0%,all P<0.001;7.69%(12/156),P=0.002,P<0.001].The gestational weeks of delivery in group E[38.0(36.0,39.0)weeks]was significantly lower than that in group C[39.0(38.0,39.3)weeks,P<0.001].Compared with the one embryo transfer group(group A,group C),the birth weight of the two embryos transfer group(group B,group D,group E)was significantly lower(P<0.001).The low birth weight infants rate in group D[20.90%(14/67)]and group E[28.40%(48/169)]was significantly higher than that in group C[3.85%(5/130),P<0.001].Logistic regression analysis showed that after adjusted,the pregnancy rate in group C was significantly higher than that in group A(OR=0.353,95%CI:0.125-0.997,P=0.049).The live birth rate of group E was significantly higher than that of group C(OR=1.842,95%CI:1.172-2.895,P=0.008),and the premature delivery rate of groups B,D and E was significantly higher than that of group C(OR=2.546,95%CI:1.079-6.005,P=0.033;OR=6.737,95%CI:2.566-17.689,P<0.001;OR=5.863,95%CI:2.494-13.785,P<0.001).ConclusionOn day 4 of the fresh cycle,the pregnancy rate and the live birth rate of the full compaction or above embryos are significantly higher than those of the partial compaction embryos.In clinical work,it is recommended to select full compaction embryos or above,and then select partially compaction embryos for single embryo transfer to achieve optimal pregnancy outcomes while reducing the multiple pregnancy rate,premature delivery rate,and low birth weight infant rate.