摘要
目的探讨新鲜周期与不同内膜准备方案冻融胚胎移植(frozen-thawed embryo transfer,FET)周期对母胎结局的影响,以指导临床咨询与应用。方法本研究为回顾性队列研究,分析2014年1月至2017年6月期间在北京大学第三医院妇产科生殖医学中心进行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)助孕,获得分娩22395个连续周期的临床资料,根据不同移植方案分为3组:新鲜周期组、自然周期(natural cycle,NC)-FET组、激素替代治疗(hormone replacement therapy,HRT)-FET组。研究主要结局指标为产科母胎结局,次要结局指标为各组生殖相关临床资料、实验室相关指标等基本资料情况,并进一步采用logistic回归分析周期对各产科结局的影响。结果本研究新鲜周期组12118个,NC-FET组6648个,HRT-FET组3629个。基本特征中:①三组间不孕年限差异有统计学意义(P=0.007),女方年龄、女性体质量指数(body mass index,BMI)、男方年龄、不孕类型比例、人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)注射日/转化日内膜厚度差异均有显著统计学意义(均P<0.001),其中内膜厚度在新鲜周期组最厚[(11.13±1.63)mm],NC-FET组次之[(10.61±1.74)mm],HRT-FET组[(9.77±1.58)mm]最低。②FET周期囊胚移植比例[NC-FET组54.8%(3646/6648)、HRT-FET组52.4%(1901/3629)]较新鲜周期组[3.8%(461/12118)]增加(P<0.001)。③囊胚移植后单卵双胎的发生率增加(P<0.001)。母胎结局:①三组间活产率差异有统计学意义(P=0.011)。②三组间分娩孕周差异有统计学意义[新鲜周期组(38.39±2.08)周、NC-FET组(38.69±1.87)周、HRT-FET组(38.40±2.31)周,P<0.001];NC-FET组和HRT-FET组的足月引产率[19.8%(1315/6648)、19.0%(690/3629)]、新生儿体质量[(3168.05±607.90)g、(3124.70±683.53)g]、巨大儿出生率[7.8%(521/6648)、8.5%(309/3629)]均高于新鲜周期组[16.6%(2017/12118)、(3007.61±627.60)g、6.6%(804/12118),均P<0.001]。③HRT-FET组早产率[16
Objective To perform a comparative study of obstetric outcomes in fresh cycles and different endometrial preparation protocols in frozen-thawed embryo transfer(FET)cycles,in order to guide the follow-up clinical consulting service and applications.Methods This retrospective cohort study was conducted in a cohort of 22395 consecutive cases with live birth following successful in vitro fertilization and embryo transfer(IVF-ET)/FET performed at the Center for Reproductive Medicine,Department of Obstetrics and Gynecology of Peking University Third Hospital from January 2014 to June 2017.According to the method of embryo transfer cycles,they were divided into fresh cycle group,natural cycle(NC)-FET cycle group and hormone replacement therapy(HRT)-FET cycle group.The primary outcome indicators of the study were the maternal and fetal outcomes in obstetrics,and the secondary outcome indicators were the basic data such as reproductive-related clinical data and laboratory-related indicators in each group.Logistic regression was used to analyze the influence of cycles on the obstetrical outcomes.Results Among the 22395 cycles,there were 12118 cycles in fresh group,6648 cycles in NC-FET group,and 3629 cycles in HRT-FET group.Among the basic characteristics:1)There was a statistical difference in infertility duration among the three groups(P=0.007),and differences were also found in female age,female body mass index(BMI),male age,the proportion of infertile type,and mean endometrial thickness on human chorionic gonadotropin(hCG)/conversion day among the three groups(all P<0.001);the mean endometrial thickness among the women with the fresh cycles[(11.13±1.63)mm]was the thickest,followed by the NC-FET cycles[(10.61±1.74)mm]and the lowest in the HRT-FET cycles[(9.77±1.58)mm].2)The proportion of blastocysts transferred increased in the FET cycles[NC-FET cycles 54.8%(3646/6648),HRT-FET cycles 52.4%(1901/3629)]compared with fresh cycles[3.8%(461/12118),P<0.001].3)The incidence of monozygotic twins after blastocyst transfer inc
作者
郭薇
王琳琳
陈立雪
田甜
王媛媛
杨蕊
刘平
李蓉
乔杰
Guo Wei;Wang Linlin;Chen Lixue;Tian Tian;Wang Yuanyuan;Yang Rui;Liu Ping;Li Rong;Qiao Jie(Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Peking University Third Hospital,Beijing 100191,China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2022年第12期1241-1249,共9页
Chinese Journal of Reproduction and Contraception
基金
国家重点研发计划(2021YFC2700605)
北京市科技计划(Z191100006619085)
国家自然科学基金(82171632)。
关键词
妊娠并发症
生殖技术
辅助
母胎结局
胚胎移植策略
Pregnancy complications
Reproductive technology,assisted
Maternal-fetal outcome
Embryo transfer strategy
