不同BMI水平新鲜胚胎移植和全胚冷冻-首次冻融胚胎移植妊娠结局比较

目的比较不同体重指数(BMI)水平患者新鲜胚胎移植和全胚冷冻-首次冻融胚胎移植(FET)的妊娠结局。方法回顾性分析2009年1月至2018年5月于郑州大学第一附属医院生殖医学中心行首次新鲜胚胎移植(13019个周期)和全胚冷冻后首次FET(3546个周期)患者的临床资料。将研究对象按不同BMI分为正常体重组(18.5~23.9 kg/m2)、超重组(23.9~27.9 kg/m2)和肥胖组(≥28 kg/m2)。分析不同BMI水平下鲜胚移植组和FET组患者的临床特征和妊娠结局,采用多元Logistic回归分析矫正影响妊娠结局的混杂因素;主要结局指标包括临床妊娠率、活产率、流产率。结果矫正各种混杂因素后,正常体重组中,FET组的临床妊娠率、活产率显著低于鲜胚移植组,而流产风险显著高于鲜胚移植组P<0.05;临床妊娠率:aOR=0.80(95%CI:0.71-0.91);活产率:aOR=0.77(95%CI:0.68-0.86);流产率:aOR=1.28(95%CI:1.05-1.58)];超重组中,FET组的临床妊娠率、活产率显著低于鲜胚移植组,流产风险显著高于鲜胚移植组P<0.05;临床妊娠率:aOR=0.76(95%CI:0.61-0.94);活产率:aOR=0.74(95%CI:0.60-0.92);流产率:aOR=1.23(95%CI:0.87-0.96)];肥胖组中,鲜胚移植组和FET组间临床妊娠率、活产率及流产率比较均无显著性差异(P>0.05)。结论对于正常体重和超重人群,在无影响新鲜胚胎移植因素存在时,尽量选择新鲜胚胎移植;肥胖人群中两种移植方式则无明显差异。

Comparison of pregnancy outcomes between fresh embryo transfer and the first frozen-thawed embryo transfer at different BMI levels

Objective:To compare the pregnancy outcomes between fresh embryo transfer and the first frozen-thawed embryo transfer following“whole embryo freezing”strategy at different BMI level.Methods:The data of 13019 fresh embryo transfer cycles and 3546 frozen-thawed embryo transfer cycles following“whole embryo freezing”strategy in the First Affiliated Hospital of Zhengzhou University from Jan.2010 to May 2018 were retrospectively analyzed.The patients are divided into three groups according to the BMI levels:normal weight group(18.5-23.9 kg/m2),overweight group(23.9-27.9 kg/m2)and obesity group(≥28 kg/m2).The clinical characteristics and pregnancy outcome were compared among the three groups.A multi-level logistic regression analysis was used to evaluate the pregnancy outcome between fresh embryo transfer and the first frozen-thawed embryo transfer.The main outcome measures were clinical pregnancy rate,live birth rate and miscarriage rate.Results:After adjusting for confounders,the clinical pregnancy rate and live birth rate of FET group were significantly lower,while the risk of abortion was significantly higher than that of fresh embryo transfer groupP<0.05;clinical pregnancy rate:aOR=0.80(95%CI:0.71-0.91);live birth rate:aOR=0.77(95%CI:0.68-0.86);abortion rate:aOR=1.28(95%CI:1.05-1.58)]in normal weight group.In the overweight group,the clinical pregnancy rate and live birth rate of FET group were significantly lower,and the risk of abortion was significantly higher than that of fresh embryo transplantation groupP<0.05;clinical pregnancy rate:aOR=0.76(95%CI:0.61-0.94);live birth rate:aOR=0.74(95%CI:0.60-0.92);abortion rate:aOR=1.23(95%CI:0.87-0.96)].In the obesity group,there was no significant difference in clinical pregnancy rate,live birth rate and abortion rate between fresh embryo transplantation group and FET group(P>0.05).Conclusions:For normal weight and overweight patients,fresh embryo transfer should be selected as far as possible when there are no factors affecting fresh embryo transfer.There is no significant difference between the two methods in obese patients.