玻璃化冷冻胚胎和新鲜胚胎移植的临床结局比较

目的 探讨玻璃化冷冻胚胎移植(FET)和新鲜胚胎移植(NET)的临床结局。方法回顾性分析2013年1月至2014年3月在中山大学孙逸仙纪念医院行体外受精-新鲜胚胎移植(IVF-NET)577个周期及单精子卵细胞浆内显微注射-新鲜胚胎移植(ICSI-NET)118个周期、FET 175个周期共870个周期的临床资料,比较NET组和FET组(曾经NET未成功妊娠,后行FET者)的临床特征和助孕结局,再将FET组分为妊娠亚组和未妊娠亚组进一步分析比较。采用二分类logistic回归分析影响妊娠结局的因素。结果 FET组的种植率(26.27% vs. 31.98%,P=0.01)、临床妊娠率(47.43% vs. 65.18%,P<0.001)均明显低于NET组,差异均有统计学意义;FET组的流产率(P=0.63)、生化妊娠率(P=0.17)和胎儿出生体重(P=0.33)与NET组相比差异均无统计学意义。FET组中妊娠亚组与未妊娠亚组女方年龄(30.69岁±3.37岁 vs. 32.00岁±5.09岁,P=0.03)的差异有统计学意义;BMI、不孕年限、基础内分泌等指标的差异均无统计学意义。二分类logistic回归分析显示是否行FET(P<0.001)、女方年龄(P<0.001)、BMI(P=0.011)和优质胚胎数(P<0.001)为影响妊娠结局的因素。结论 曾经行NET未成功的妊娠者,随后使用FET者其种植率和妊娠率均较低,但不增加流产率,未影响胎儿出生体重,未发现FET对妊娠结局有不良影响。

Comparison of clinical outcomes of vitrified-thawed embryo transfer and fresh embryos transfer

Objective To understand the clinical outcomes of frozen embryo transfer and fresh embryo transfer. Methods A retrospective analysis was conducted on the clinical data of 870 cases receiving embryo transfer at the Reproductive Medical Center of Sun Yat-Sen Memorial Hospital from January 2013 to March 2014,including 577 cases of in vitro fertilization and fresh embryo transfer,118 cases of intracytoplasmic sperm injection and fresh embryo transfer and 175 cases of frozen thawed embryo transfer,to compare the clinical characteristics and outcomes between fresh embryo transfer group and frozen embryo transfer group (the patients who had received unsuccessful fresh embryo transfer). The frozen embryo transfer group was divided into pregnant subgroup and non pregnant subgroup to further comparison. Binary logistic regression analyses was performed to identify the influencing factors of pregnancy. Results The implantation rate and clinical pregnancy rate were significantly lower in frozen embryo transfer group than in fresh embryo transfer group (26.27% vs. 31.98%,P=0.01 and 47.43% vs. 65.18%,P<0.001). The differences in abortion rate,biochemical pregnancy rate and fetal birth weight had no statistical significance between the two groups (P=0.63,P=0.17 and P=0.33). The difference in age between pregnant subgroup and non pregnant subgroup was statistical significant (30.69±3.37 years vs. 32.00±5.09 years,P=0.03),but no significant differences were found in BMI,duration of infertility and basic endocrine between the two subgroups. Binary logistic regression analysis showed that receiving frozen embryo transfer or not(P<0.001),wife''s age(P<0.001),BMI(P=0.011) and number of top quality embryos(P<0.001) were influencing factors of pregnancy. Conclusion Lower implantation rate and clinical pregnancy rate was observed in the patients in frozen embryo transfer group,who had received unsuccessful fresh embryo transfer,but no increase of abortion rate,influence on fetal birth weight and adverse pregnancy outcome were observed.