摘要
目的探讨≥35岁(35~48岁)高龄不孕患者IVF/ICSI-ET新鲜周期不同移植策略的妊娠结局。方法回顾性分析2015年1月至2021年12月在我院生殖医学中心行IVF/ICSI-ET治疗的1492个新鲜移植周期患者的临床资料。根据不孕患者年龄分两个年龄段:35~37岁(681个周期)和≥38岁(811个周期);同时,再根据移植胚胎情况分为A组(移植1个优质卵裂胚)、B1组(移植1个优质卵裂胚+1个低序列非优质卵裂胚)、B2组(移植1个优质卵裂胚+1个高序列非优质卵裂胚)、B3组(移植2个优质卵裂胚)、C组(移植单个囊胚)等5个亚组,分别比较不同年龄段各亚组间患者的临床资料和妊娠结局。结果≥38岁年龄段中,C组平均年龄和不孕年限显著低于其他各组(P<0.05)。在35~37岁年龄段中,C组种植率显著高于A组(P<0.05),B3组和C组临床妊娠率显著高于A组(P<0.05),B1、B2和B3组多胎率显著高于A组和C组(P<0.05),B3组多胎率显著高于B1和B2组(P<0.05),各组间流产率比较无显著差异(P>0.05),A组活产率显著低于其他各亚组(P<0.05);在≥38岁年龄段中,C组种植率显著高于A组(P<0.05),B2、B3组和C组临床妊娠率显著高于A组(P<0.05),B3组临床妊娠率显著低于C组(P<0.05),B2和B3组多胎率显著高于A组和C组(P<0.05),B2组流产率显著低于B1组(P<0.05),B2、B3和C组活产率显著高于A组(P<0.05),B3组活产率显著低于B2和C组(P<0.05)。多因素Logistic回归分析结果显示,B2组的临床妊娠率和活产率显著高于A组(P<0.05)。结论单囊胚移植是目前新鲜胚胎移植的最优策略;而对于年龄≥38岁的患者,1个优质卵裂胚+1个高序列非优质卵裂胚移植也可以获得与单囊胚移植相同的活产率。
Objective:To explore the pregnancy outcomes of different transplantation strategies in IVF/ICSI ET fresh cycles in the infertile patients aged≥35 years(35-48 years).Methods:The clinical data of 1492 fresh embryo transfer cycles of the patients who underwent IVF/ICSI-ET treatment at our Reproductive Medicine Center from January 2015 to December 2021 were analyzed retrospectively.According to age of the infertile patients,they were divided into 35-37 years old group(681 cycles),and≥38 years old group(811 cycles).Then each group was divided into 5 subgroups according to the status of embryo transferred:group A(1 good-quality cleavage embryo),group B1(1 good-quality cleavage embryo+1 low-sequence non-good-quality cleavage embryo),group B2(1 good-quality cleavage embryo+1 high-sequence non-good-quality cleavage embryo),group B3(2 good-quality cleavage embryos),and group C(single blastocyst).The clinical data and pregnancy outcome of each subgroup were compared.Results:In the women≥38 years old,the average age and infertility duration in group C were significantly lower than those in other groups(P<0.05).In the women with 35-37 years,the implantation rate in group C was significantly higher than that in group A(P<0.05).The clinical pregnancy rate in group B3 and group C was significantly higher than that in group A(P<0.05).The multiple birth rate in groups B1,B2,and B3 was significantly higher than that in groups A and C(P<0.05).The multiple birth rate in group B3 was significantly higher than that in groups B1 and B2(P<0.05).There was no significant difference in the abortion rate between groups(P>0.05),and the live birth rate in group A was significantly lower than that in other subgroups(P<0.05).In the women≥38 years old,the implantation rate in group C was significantly higher than that in group A(P<0.05).The clinical pregnancy rate in group B2,B3,and C was significantly higher than that in group A(P<0.05).The clinical pregnancy rate in group B3 was significantly lower than that in group C(P<0.05).The multi
作者
郑炜炜
何毅超
祝晓丽
林盛
刘善文
崔媛媛
宋革
ZHENG Wei-wei;HE Yi-chao;ZHU Xiao-li;LIN Sheng;LIU Shan-wen;CUI Yuan-yuan;SONG Ge(NHC Key Laboratory of Male Reproduction&Genetics,Guangdong Provincial Reproductive Science Institute(Guangdong Provincial Fertility Hospital),Guangzhou 510600;Reproductive Medicine Center of Guangdong Provincial fertility Hospital,Guangdong Provincial Reproductive Science Institute,Guangzhou 510060)
出处
《生殖医学杂志》
CAS
2023年第7期1013-1020,共8页
Journal of Reproductive Medicine
基金
广东省医学科研基金项目(A2020604)。
