目的:冷冻冷冻保存胚胎超过5年是否会影响冷冻胚胎移植(FET)后的妊娠结局?
结论:冷冻冷冻保存优质胚泡超过5年与植入率(IR)和活产率(LBR)降低有关。
背景:先前的研究主要集中在冷冻保存相对较短持续时间(少于5年)的胚胎上,然而,延长冷冻保存时间对妊娠结局的影响仍是一个有争议的问题.关于储存胚胎5年或更长时间的功效和安全性的数据相对缺乏。
方法:这项回顾性研究涉及2016年1月1日至2022年12月31日在中国单一生育中心进行的36.665个合格的玻璃化解冻胚胎移植周期。
方法:根据胚胎保存时间将患者分为三组:第1组包括31.565个周期,储存时间为0-2年;第2组包括4458个周期,储存时间为2-5年;第3组包括642个周期,储存时间超过5年。主要结果指标为IR和LBR。次要结果变量包括生化妊娠率,多胎妊娠,异位妊娠,和流产,以及新生儿结局。将生殖结果作为二元变量进行分析。采用多因素logistic回归分析,探讨校正混杂因素后保存时间对妊娠结局的影响。此外,我们还评估了新生儿结局,例如胎龄大(LGA)和胎龄小(SGA)。
结果:三组(0-2,2-5和>5年)的IRs为37.37%,39.03%,35.78%,分别为(P=0.017),三组的LBRs为37.29%,39.09%,34.91%,分别为(P=0.028)。在调整了潜在的混杂因素后,与0-2年储存组相比,延长胚胎玻璃化保存时间(2-5年或>5年)不影响次要结局,如生化妊娠率,多胎妊娠,异位妊娠,流产(P>0.05)。但是冷冻保存胚胎超过5年降低了IR(调整比值比(aOR)0.82,95%CI0.69-0.97,P=0.020)和LBR(aOR0.76,95%CI0.64-0.91,P=0.002)。多因素分层分析还显示,延长囊胚冷冻保存时间(>5年)可降低IR(aOR0.78,95%CI0.62-0.98,P=0.033)和LBR(aOR0.68,95%CI0.53-0.87,P=0.002)。然而,对卵裂胚胎无影响(P>0.05)。我们进一步根据转移的冷冻囊胚的数量和质量进行了分层分析,结果表明,在>5年的储存组中,优质胚泡转移后的FET结果受到负面影响。然而,非优质囊胚的储存时间与妊娠结局无显著相关.关于新生儿结局(单胎),胚胎玻璃化保存时间对早产率无影响,胎儿出生体重,或新生儿性别比例。然而,随着储存时间的增加,SGA率(5.60%,4.10%,和1.18%)下降,而LGA的比率(5.22%,6.75%,和9.47%)增加(P<0.05)。在调整混杂因素后,LGA的增加和SGA的减少与储存时间的持续时间显着相关。
结论:这是一项回顾性研究,使用来自单个生育中心的数据,即使数据已经调整,我们的发现仍需要在进一步的研究中得到验证.
结论:随着二胎政策在中国的全面实施,将来可能会有更多的患者将胚胎冷冻了更长的时间。患者应注意,当冷冻保存时间超过5年时,胚泡的IR和LBR会受到负面影响。因此,夫妇可以考虑缩短直到FET处理的时间。
背景:这项研究得到了国家自然科学基金会的支持(编号:82101672),广州市科技项目(编号:2024A03J0180),广州市卫生健康委员会西医指导纲要(编号:20231A011096),和广州市医学重点学科(2021-2023年)。没有任何作者有任何利益冲突声明。
背景:不适用。
OBJECTIVE: Does
vitrification cryopreservation of embryos for more than 5 years affect the pregnancy outcomes after frozen embryo transfer (FET)?
CONCLUSIONS: Vitrification cryopreservation of good-quality blastocysts for more than 5 years is associated with a decrease in the implantation rate (IR) and live birth rate (LBR).
BACKGROUND: Previous studies have predominantly focused on embryos cryopreserved for relatively short durations (less than 5 years), yet the impact of extended cryopreservation duration on pregnancy outcomes remains a controversial issue. There is a relative scarcity of data regarding the efficacy and safety of storing embryos for 5 years or longer.
METHODS: This retrospective study involved 36 665 eligible vitrified-thawed embryo transfer cycles from 1 January 2016 to 31 December 2022, at a single fertility center in China.
METHODS: Patients were divided into three groups according to embryo storage time: Group 1 consisted of 31 565 cycles, with storage time of 0-2 years; Group 2 consisted of 4458 cycles, with a storage time of 2-5 years; and Group 3 included 642 cycles, with storage time exceeding 5 years. The main outcome measures were IR and LBR. Secondary outcome variables included rates of biochemical pregnancy, multiple pregnancy, ectopic pregnancy, and miscarriage, as well as neonatal outcomes. Reproductive outcomes were analyzed as binary variables. Multivariate logistic regression analysis was used to explore the effect of preservation time on pregnancy outcomes after correcting for confounding factors. In addition, we also assessed neonatal outcomes, such as large for gestational age (LGA) and small for gestational age (SGA).
RESULTS: IRs in the three groups (0-2, 2-5, and >5 years) were 37.37%, 39.03%, and 35.78%, respectively (P = 0.017), and LBRs in the three groups were 37.29%, 39.09%, and 34.91%, respectively (P = 0.028). After adjustment for potential confounding factors, compared with the 0-2 years storage group, prolonged embryo
vitrification preservation time (2-5 years or >5 years) did not affect secondary outcomes such as rates of biochemical pregnancy, multiple pregnancy, ectopic pregnancy, and miscarriage (P > 0.05). But cryopreservation of embryos for more than 5 years reduced the IR (adjusted odds ratio (aOR) 0.82, 95% CI 0.69-0.97, P = 0.020) and LBR (aOR 0.76, 95% CI 0.64-0.91, P = 0.002). Multivariate stratified analysis also showed that prolonging the cryopreservation time of blastocysts (>5 years) reduced the IR (aOR 0.78, 95% CI 0.62-0.98, P = 0.033) and LBR (aOR 0.68, 95% CI 0.53-0.87, P = 0.002). However, no effect on cleavage embryos was observed (P > 0.05). We further conducted stratified analyses based on the number and quality of frozen blastocysts transferred, and the results showed that the FET results after transfers of good-quality blastocysts in the >5 years storage group were negatively affected. However, the storage time of non-good-quality blastocysts was not significantly associated with pregnancy outcomes. Regarding the neonatal outcomes (of singletons), embryo
vitrification preservation time had no effect on preterm birth rates, fetal birth weight, or neonatal sex ratios. However, as the storage time increased, rates of SGA (5.60%, 4.10%, and 1.18%) decreased, while rates of LGA (5.22%, 6.75%, and 9.47%) increased (P < 0.05). After adjusting for confounding factors, the increase in LGA and the decrease in SGA were significantly correlated with the duration of storage time.
CONCLUSIONS: This was a retrospective study using data from a single fertility center, even though the data had been adjusted, our findings still need to be validated in further studies.
CONCLUSIONS: With the full implementation of the two-child policy in China, there may be more patients whose embryos have been frozen for a longer time in the future. Patients should be aware that the IR and LBR of blastocysts are negatively affected when the cryopreservation time is longer than 5 years. Couples may therefore consider shortening the time until FET treatment.
BACKGROUND: This study was supported by the National Nature Science Foundation of China (No. 82101672), Science and Technology Projects in Guangzhou (No. 2024A03J0180), General Guidance Program for Western Medicine of Guangzhou Municipal Health Commission (No. 20231A011096), and the Medical Key Discipline of Guangzhou (2021-2023). None of the authors have any conflicts of interest to declare.
BACKGROUND: N/A.