新鲜周期第4天和第5天移植临床结局及母婴结局比较

Comparison of clinical outcomes and maternal and fetal outcomes between day 4 and day 5 embryo transfer in fresh cycle

目的探讨新鲜周期第4天(day 4,D4)胚胎移植对体外受精(in vitro fertilization,IVF)或卵胞质内单精子注射(intracytoplasmic sperm injection,ICSI)临床结局及母婴结局的影响。方法回顾性队列研究分析了2019年1月至2021年12月期间就诊于邢台不孕不育专科医院生殖医学中心在受精后D4或第5天(day 5,D5)移植1枚最优质的胚胎行IVF或ICSI的患者临床资料。比较D4移植组(n=273)和D5移植组(n=88)的临床结局及母婴结局。结果D5移植组人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)注射日雌二醇水平[3516(2273,4116)ng/L]显著高于D4移植组[2940(1935,3877)ng/L,P=0.023],hCG注射日黄体生成素(luteinizing hormone,LH)水平[0.82(0.63,1.11)μg/L]显著低于D4移植组[0.94(0.69,1.20)μg/L,P=0.026]。D5移植组的双原核(two pronuclei,2PN)受精率[71.13%(929/1306)]和可用胚胎率[51.73%(509/984)]显著高于D4移植组[67.26%(2539/3775),P=0.010;48.00%(1306/2721),P=0.045],D4移植组的临床妊娠率[63.37%(173/273)]和活产率[53.11%(145/273)]显著高于D5移植组[46.59%(41/88),P=0.005;36.36%(32/88),P=0.006]。两组间的异位妊娠率、单卵双胎率、流产率、早产率、死产率、剖宫产率、分娩孕周、男/女比例及出生体质量等差异均无统计学意义(均P>0.05)。logistic回归分析结果显示胚胎移植天数对临床妊娠率和活产率的影响呈显著相关性(OR=0.468,95%CI:0.266~0.824,P=0.009;OR=0.481,95%CI:0.273~0.847,P=0.011)。结论IVF/ICSI中新鲜周期D4移植临床妊娠率及活产率均优于D5移植,母婴结局相当,在临床工作中可考虑优先选择D4胚胎移植。

Objective To investigate the effects of day 4(D4)embryo transfer on clinical outcomes and maternal and infant outcomes in vitro fertilization(IVF)or intracytoplasmic sperm injection(ICSI)in fresh cycles.Methods We retrospectively analyzed the clinical data of 361 IVF and ICSI cycles from January 2019 to December 2021 in the Reproductive Medicine Center of Xingtai Infertility Specialist Hospitals in a cohort study.In all cycles,one of the best quality embryo was transferred at D4 or D5 after fertilization.The clinical outcomes and maternal and fetal outcomes of D4 transfer group and D5 transfer group were compared.Results Compared with D4 transfer group,the estradiol value on human chorionic gonadotropin(hCG)injection day significantly increased in D5 transfer group[3516(2273,4116)ng/L vs.2940(1935,3877)ng/L,P=0.023],and the luteinizing hormone(LH)value on hCG injection day significantly decreased[0.82(0.63,1.11)μg/L vs.0.94(0.69,1.20)μg/L,P=0.026],two pronuclei(2PN)fertilization rate[71.13%(929/1306)]and the available embryo rate[51.73%(509/984)]in D5 transfer group were significantly higher than those in D4 transfer group[67.26%(2539/3775),P=0.010;48.00%(1306/2721),P=0.045].The clinical pregnancy rate[63.37%(173/273)]and the live birth rate[53.11%(145/273)]in D4 transfer group were significantly higher than those in D5 transfer group[46.59%(41/88),P=0.005;36.36%(32/88),P=0.006].There were no significant differences in ectopic pregnancy rate,monozygotic twins rate,abortion rate,preterm birth rate,stillbirth rate,caesarean section rate,delivery gestation,male/female ratio and birth weight(all P>0.05).The results of logistic regression analysis showed that the days of embryo transfer had a significant correlation with the pregnancy rate and the live birth rate(OR=0.468,95%CI:0.266-0.824,P=0.009;OR=0.481,95%CI:0.273-0.847,P=0.011).Conclusion In IVF/ICSI of fresh cycles,the clinical pregnancy rate and the live birth rate of D4 transplantation are better than that of D5 transplantation,and the maternal and fetal outcomes are similar.Therefore,D4 embryo transplantation can be preferred in clinical work.