薄型子宫内膜新鲜胚胎和冻融胚胎移植妊娠结局比较

目的探讨在薄型子宫内膜患者中新鲜胚胎移植与冻融胚胎移植(FET)妊娠结局的差异。方法回顾性分析接受体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)治疗采用长方案胚胎移植h CG注射日与冻融周期胚胎移植内膜转化日的内膜厚度≤7 mm的患者共592个周期的临床资料。将移植周期按胚胎是否冻融分为新鲜胚胎移植组(n=173)和FET组(n=419)。比较组间的胚胎种植率、临床妊娠率、流产率、多胎率和异位妊娠率有无差异。结果新鲜胚胎移植组患者平均移植胚胎(2.1±0.4)枚,与FET组患者平均移植胚胎(2.1±0.5)枚比较,组间有统计学差异(P0.05);按照移植胚胎数分为3个亚组,新鲜胚胎移植组1枚胚胎者,妊娠率为7.7%,2枚者为30.2%,3枚者为23.8%;FET组1枚胚胎者15.6%,2枚者为34.9%,3枚者为41.6%,新鲜胚胎移植组与FET组间差异均无统计学意义(P0.05)。组间着床率、流产率、异位妊娠率等结果也均无统计学差异(P0.05)。移植3枚胚胎新鲜组多胎率(80.0%)高于FET组(29.7%)(P0.05)。新鲜胚胎移植组多胎率3个亚组间有统计学差异(P0.05),FET组妊娠率和流产率3个亚组间均有统计学差异(P0.05)。将移植胚胎数作为协变量,纳入Logistics回归模型对结果变量进行分析,说明周期类型与临床妊娠率间无显著相关性(OR=0.726,95%CI=0.504~1.104)。结论子宫内膜厚度≤7 mm的薄型内膜患者新鲜胚胎移植和FET妊娠结局相似,选择新鲜周期移植不影响妊娠结局并可缩短治疗周期,降低总费用。

Comparison of pregnancy outcome in patients with thin endometrium undergoing fresh embryos and frozen thawed embryo transfer

Objective To study the differences of pregnancy outcome in patients with thin endometrium underdoing fresh embryo transfer and frozen-thawed embryo transfer (FET).Methods Retrospective analysis was performed in patients with the endometrial thickness ≤ 7 mm on hCG injection day and FET endometrial transformation day who received in vitro fertilization/intracytoplastic sperm injectionembryo transfer (IVF/ICSI-ET) treatment,including 592 cycles of clinical data.According to transplanted embryos whether or not be frozen-thawed,all patients were divided into two groups:fresh embryo transfer group (173 cases),FET group (419 cases).The rates of embryo implantation,clinical pregnancy rate,spontaneous abortion rate,multiple birth rate and ectopic pregnancy rate were compared between the two groups.Results The number of embryos transferred in fresh embryo transfer group was 2.1 ± 0.4 and FET group was 2.1 ± 0.5 (P＜0.05).According to the number of embryos transferred 1,2,3 were divided into 3 subgroups,the pregnancy rate between the three groups (one embryo:7.7％ and 15.6％,two embryos:30.2％ and 34.9％,three embryos:23.8％ and 41.6％),the difference was not statistically significant.There were no significant differences in spontaneous abortion rate and ectopic pregnancy rates among the two groups (P＞0.05).The rate of multiple births in the fresh group of 3 embryos (80.0％) was higher than that in the FET group (29.7％,P＜0.05).In the transplantation group,fresh embryos of different multiple fetal rate differences (P＜0.05),FET group of different number of transferred embryos on pregnancy rate and abortion rate differed (P＜0.05).The number of transplanted embryos were used as covariates,and the results were analyzed by Logistics regression model.There was no significant correlation between cycle type and clinical pregnancy rate (OR=0.726,95％ CI=0.504-1.104).Conclusion The pregnancy outcomes are similar in patients with endometrial thickness ≤7 mm between fresh embryo transfer group and FET group.Choosing fresh embryo transfer cycles does not affect the outcome of pregnancy,can shorten the treatment cycle,and reduce the total cost.