目的:探讨不同年龄女性进行冻融优质单囊胚移植的可行性。
方法:将1,279名妇女分为四组:38-40岁组(n=147),35-37岁组(n=164),30-34岁组(n=483),<30岁组(n=485)。进行基线特征和妊娠及新生儿结局的组间比较。
结果:临床妊娠率(47.6%),38-40岁组的活产率(34.0%)显着低于30-34岁组(64.4%,50.9%,分别;所有P<0.001)和<30岁组(62.9%,50.7%,分别;所有P<0.001)。然而,35~37岁组与其他三组在这两个维度上差异均无统计学意义(均P>0.05)。此外,生化妊娠率没有差异,流产,或产科或新生儿并发症四组(均P>0.05)。根据多元逻辑回归分析,35-37岁组与非活产结局无关,不良妊娠结局,或产科或新生儿并发症。然而,38-40岁是非活产(OR=2.121,95%CI:1.233-3.647)和不良妊娠结局(OR=1.630,95%CI:1.010-2.633)的危险因素。事后功效分析表明,该研究具有足够的功效来检测有意义的差异。
结论:冻融的高质量单囊胚移植对35-37岁女性的妊娠结局与年轻患者相同。未来需要更大人群的前瞻性随机对照研究来验证该方法的可行性和安全性。
OBJECTIVE: To investigate the feasibility of performing frozen-thawed high-quality single blastocyst transfer in women of different ages.
METHODS: A total of 1,279 women were divided into four groups: a 38-40-year-old group (n = 147), 35-37-year-old group (n = 164), 30-34-year-old group (n = 483), and < 30-year-old group (n = 485). Intergroup comparisons of baseline characteristics and pregnancy and neonatal outcomes were made.
RESULTS: The clinical pregnancy rate (47.6%), and live birth rate (34.0%) in the 38-40-year-old group were significantly lower than those in the 30-34-year-old group (64.4%, 50.9%, respectively; all P < 0.001) and < 30-year-old group (62.9%, 50.7%, respectively; all P < 0.001). However, the 35-37-year-old group did not differ from the other three groups in these two dimensions (all P > 0.05). Moreover, there were no differences in the rates of biochemical pregnancy, miscarriage, or obstetric or neonatal complications among the four groups (all P > 0.05). According to the multivariate logistic regression analysis, the 35-37-year-old group was not associated with non-live birth outcomes, adverse pregnancy outcomes, or obstetric or neonatal complications. However, being 38-40 years of age was a risk factor for non-live birth (OR = 2.121, 95% CI: 1.233-3.647) and adverse pregnancy outcomes (OR = 1.630, 95% CI: 1.010-2.633). Post hoc power analysis showed that the study was sufficiently powered to detect meaningful differences.
CONCLUSIONS: Frozen-thawed high-quality single blastocyst transfer produces the same satisfactory pregnancy outcomes for women aged 35-37 years as younger patients. Future prospective randomized controlled studies with larger populations are needed to verify the feasibility and safety of this method.