冻融胚胎移植异位妊娠低发生率的原因分析

目的比较新鲜胚胎移植或解冻胚胎移植妇女异位妊娠的发生情况,及冻融胚胎移植周期中不同内膜准备方案异位妊娠发生情况,分析其相关影响因素。方法对2006年1月至2013年5月于本生殖医学中心行体外受精/卵胞浆内单精子注射(IVF/ICSI)-胚胎移植术后的患者进行回顾性分析,包括3,073个新鲜移植周期(A组)、2,090个解冻移植周期(B组),其中卵裂期胚胎移植1,997个周期(B1组),囊胚移植93个周期(B2组)。比较A组与B1组、A组与B2组异位妊娠发生率;比较自然周期法、激素替代周期法和促排卵周期三种内膜准备方案异位妊娠发生率;多元logistic回归分析异位妊娠相关因素。结果 3,073个新鲜移植周期(A组)中,临床妊娠1,226周期,异位妊娠45周期,异位妊娠发生率为3.67%(45/1,226);2,090个解冻周期中,临床妊娠893周期(B1组855周期,B2组38周期),B1组异位妊娠发生率1.17%(10/855),B2组异位妊娠发生率2.63%(1/38),两组异位妊娠发生率均低于新鲜胚胎移植,有显著性差异(P0.05);冻融胚胎移植内膜准备方案采用自然周期时异位妊娠率最低;多元logistic回归分析发现输卵管病变、移植当日激素水平是移植后异位妊娠发生的危险因素。结论解冻胚胎移植后发生异位妊娠的几率低于新鲜周期移植,超促排卵过程或内膜准备过程中造成的高雌激素状态可能是发生异位妊娠的重要影响因素。

Incidence and cause of ectopic pregnancy after frozen-thawed embryo transfer

Objective： To compare the incidence of ectopic pregnancy（EP）between fresh and frozen-thawed（FET） embryo transfers,and explore the generant cause of EP among different endometrial preparation protocols. Methods： The data of 3,073 fresh cycles in group A and 2,090 FET cycles in group B including 1,997 cleavage-stage in group B1 and 93 blastocyst transfers in group B2 from Jan. 2006 to May. 2013 were analyzed retrospectively. The incidences of ectopic pregnancy were compared among three endometrial preparation protocols including natural cycle, hormone replacement cycle and stimulating ovulation cycle. The risk factors of EP were identified with multivariate logistic regression. Results： The incidence of ectopic pregnancy was 3.67% in 3,073 fresh cycles. In 2,090 FET cycles, both group BI（1.17%）and group B2（2.63%）had significantly lower EP rate than fresh cycles（P〈0.05）. Compared with the other endometrial preparation groups,EP rate in the natural cycle was the smallest with statistically significance. The ectopic pregnancy rate was increased in the patients with oviduct factors or high sex hormones on the embryo transfer day. Conclusions. The incidence of EP in FET cycles was lower than that fresh embryo transfer cycles. High estrogen status caused by controlled ovarian hyperstimulation or endometrial preparation protocol may contribute to the occurrence of ectopic pregnancy.