■比较五种不同的冻融胚胎移植(FET)策略对35-40岁女性的影响。
■根据移植囊胚的数量和质量将1,060例患者的数据分为五组:高质量的单囊胚组(A组,n=303),高质量双囊胚组(B组,n=176),优质加劣质双囊胚组(C组,n=273),质量差的双囊胚组(D组,n=189),和质量差的单个囊胚组(E组,n=119)。然后就主要条件进行组间比较分析,怀孕,和新生儿结局。
■A组的双胎妊娠率最低(1.97%),低出生体重儿发生率最低(3.45%),与B组明显不同,C,还有D.此外,早产率(7.89%),新生儿出生体重(3300克[3000,3637.5]),A组新生儿出生年龄(39.14周[38.43,39.61])与B组和C组不同。双囊胚移植(DBT)与20.558倍(风险比[RR]=20.558,95%置信区间[CI],6.628-63.763)和3.091倍(RR=3.091,95%CI,1.69-5.653)在未经调整的分析中增加了双胎妊娠和早产的风险,分别,与单个囊胚移植(SBT)相比。在调整后的分析中,我们观察到相似的风险估计(调整后RR=26.501,95%CI,8.503-82.592;调整后RR=3.586,95%CI,1.899-6.769).
■虽然,高质量的SBT导致比高质量的DBT更低的活产率,它还大大降低了不良妊娠的风险,从而为母亲和婴儿带来更多的好处。总的来说,我们的数据表明,高质量SBT仍然是35~40岁女性的最佳FET治疗策略,值得进一步临床应用.
To compare the effects of five different frozen-thaw embryo transfer (FET) strategies in women aged 35-40 years.
Data from 1,060 patients were divided into five groups according to the number and quality of transferred blastocysts: a high-quality single blastocyst group (group A, n= 303), a high-quality double blastocysts group (group B, n= 176), a high-quality plus poor-quality double blastocysts group (group C, n= 273), a poor-quality double blastocysts group (group D, n= 189), and a poor-quality single blastocyst group (group E, n= 119). Comparative analyses were then performed between groups with regard to primary conditions, pregnancy, and neonatal outcomes.
Group A had the lowest twin pregnancy rate (1.97%) and incidence of low-birth-weight infants (3.45%), which were significantly different from groups B, C, and D. In addition, the preterm birth rate (7.89%), neonatal birth weight (3300 g [3000, 3637.5]), and neonatal birth age (39.14 weeks [38.43, 39.61]) in group A were different from those in groups B and C. Double blastocyst transfer (DBT) was associated with a 20.558-fold (Risk Ratio [RR]=20.558, 95% confidence interval [CI], 6.628-63.763) and 3.091-fold (RR=3.091, 95% CI, 1.69-5.653) increased risk of twin pregnancy and preterm delivery in unadjusted analysis, respectively, when compared with single blastocyst transfer (SBT). In the adjusted analysis, we observed similar risk estimates (adjusted RR=26.501, 95% CI, 8.503-82.592; adjusted RR=3.586, 95% CI, 1.899-6.769).
Although, high-quality SBT resulted in a lower live birth rate than high-quality DBT, it also significantly reduced the risk of adverse pregnancies, thus resulting in more benefits for both the mother and baby. Collectively, our data indicate that high-quality SBT remains the optimal FET strategy for women aged 35-40 years and warrants further clinical application.