拮抗剂方案新鲜移植两枚卵裂期胚胎与新鲜移植单囊胚的妊娠结局比较

Comparison of the pregnancy outcomes between fresh transfers of two cleavage stage embryos and fresh transfers of a single blastocyst with antagonist regimen

目的探讨拮抗剂方案新鲜移植两枚卵裂期胚胎与新鲜移植单囊胚的临床结局。方法回顾性选取2022年1月至12月在赣州市妇幼保健院生殖与遗传科行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕治疗的97例助孕患者作为研究对象,根据移植胚胎类别分为A组(移植两枚卵裂期胚胎,55例)和B组(移植单囊胚,42例):比较两组患者的体重指数(BMI),年龄,人绒毛膜促性腺激素(HCG)日雌二醇(E2)、黄体生成素(LH)、孕酮(P)水平及促性腺激素(GN)用量,获卵数、2原核(PN)受精率、优胚率、种植率、妊娠率、流产率,囊胚形成率,卵巢过度刺激综合征(OHSS)发生率,多胎率及活产率。结果A组基础LH低于B组,差异有统计学意义(P<0.05)。两组Gn用量、Gn天数,HCG日LH、P、内膜厚度及可用胚胎数比较,差异无统计学意义(P>0.05);A组Gn启动剂量高于B组,差异有统计学意义(P<0.05);A组HCG日E2、HCG日≥14 mm卵泡数、获卵数、正常受精数、可用胚胎数及囊胚形成率均低于B组,差异有统计学意义(P<0.05)。两组HCG阳性率、临床妊娠率、流产率及活产率比较,差异无统计学意义(P>0.05);A组多胎率高于B组,差异有统计学意义(P<0.05)。A组种植率低于B组,差异有统计学意义(P<0.05)。结论拮抗剂新鲜移植两枚卵裂期胚胎可达到与单囊胚移植类似的临床妊娠率,但明显增加了多胎率。对于2PN达5个以上患者可建议行囊胚培养,单囊胚移植,降低多胎率的发生率。

Objective To investigate the clinical outcomes of fresh transfers of two embryos at the cleavage stage and fresh transfers of a single blastocyst with antagonist regimen.Methods A total of 97 pregnant patients who underwent in vitro fertilization/intracytoplasmic sperm injection-embryo transfers(IVF/ICSI-ET)assisted pregnancy treatment in Department of Reproduction and Genetics of Ganzhou Maternal and Child Health Hospital from January 2022 to December 2022 were retrospectively selected as the study objects.According to the types of transplanted embryos,they were divided into group A(with two embryos transferred in the cleavage stage,55 cases)and group B(with a single transferred blastocyst,42 cases).Body mass index(BMI),age,levels of estradiol(E2),luteinizing hormone(LH),and progesterone(P)on the day of the human chorionic gonadotropin(HCG)test,and dosage of gonadotropin(Gn)were compared between the two groups.The numbers of eggs retrieved,2 pronucleus(PN)rates after fertilization,high-quality embryo rates,implantation rates,pregnancy rates,miscarriage rates,blastocyst formation rates,incidence rates of ovarian hyperstimulation syndrome(OHSS),multiple birth rates,and live birth rates were also compared between the two groups.Results Basal LH level in group A was lower than that in group B,the difference was statistically significant(P<0.05).There were no statistically significant differences in the Gn dosage,duration of Gn treatment,the levels of LH and P on the day of HCG,the thickness of the endometrUm,and the number of available embryos between the two groups.The initial Gn dose was higher in group A than in group B,the difference was statistically significant(P<0.05).The level of E2 and number of follicles≥14 mm on the day of HCG test,number of eggs retrieved,number of normally fertilized eggs,number of available embryos,and blastocyst formation rate in group A were lower than those in group B,the differences were statistically significant(P<0.05).There were no statistically significant differences in HCG positive rates,clinical pregnancy rates,miscarriage rates,and live birth rates between the two groups(P>0.05).The multiple birth rate in group A was higher than that in group B,the difference was statistically significant(P<0.05).The implantation rate in group A was lower than that in group B,the difference was statistically significant(P<0.05).Conclusion The fresh transfer of two cleavage stage embryos using the antagonist protocol achieved a similar clinical pregnancy rate as that with the transfer of a single blastocyst,while significantly increasing the multiple birth rate.Blastocyst culture with single blastocyst transfer may be recommended for patients with up to five or more two pronuclei(2PN)to reduce the incidence of multiple births.