目标关于新鲜胚胎移植和冻融胚胎移植(FET)后多胎妊娠的产科结局的数据有限,与单胎妊娠相比,多胎妊娠和妊娠并发症增加之间的关联,强调了对这一主题进行研究的必要性。因此,本研究旨在比较新鲜胚胎移植与FET后双胎妊娠的产科和新生儿结局.设计回顾性单中心研究。参与者在2010-2022年期间IVF二胎双胎妊娠≥23周。设置加利利医疗中心,三级护理大学附属医院,以色列。方法我们对新鲜胚胎移植后的IVF双胎妊娠和FET后的产科和新生儿结局进行了比较分析。这项分析包括变量,如分娩时的胎龄,出生体重,早产率,低出生体重率,新生儿重症监护病房入院和与早产相关的并发症。结果该研究包括389例IVF双胎妊娠:新鲜胚胎移植后253例,FET后136例。与FET相比,新鲜胚胎移植后,分娩时的平均胎龄较早(34.92vs.35.88周,p=0.001),早产率(<37周)更高(70.4%vs.53.7%,p=0.001)。在调整产妇年龄后,分娩时的胎龄差异仍然显着。奇偶校验,和BMI(OR=2.11,95%CI2.11-3.27,p=0.001)。同样,在调整相同变量后,早产率的差异仍然显著(p=0.001).对于新鲜胚胎移植与FET组相比,平均出生体重较低(2179.72vs.2353.35克,p=0.003);低出生体重和极低出生体重的比率更高(71.2%vs.56.3%,p<0.001和13.5%与6.7%,分别为p=0.004)。对于新鲜胚胎移植与FET组相比,新生儿重症监护病房收治的新生儿比例较高(23.3%vs.16.0%,p=0.019),新生儿呼吸窘迫综合征(10.5%vs.5.9%,p=0.045)和需要光疗的人(23.3%vs.16.0%,p=0.019)。局限性研究的局限性包括其回顾性性质。此外,我们无法适应一些混杂因素,例如取回的鸡蛋数量,移植的胚胎数量,和卵巢刺激或制备用于胚胎移植的子宫内膜的方法。结论新鲜胚胎移植后双胎妊娠的产科和新生儿结局比FET后差。这些发现支持FET后良好的胎儿结局,并支持当前从新鲜胚胎移植向FET转移的趋势。需要前瞻性研究来支持我们的结果。
OBJECTIVE: The limited data regarding obstetrical outcomes in multiple pregnancies following both fresh embryo transfer and frozen-thawed embryo transfer (FET), along with the association between multiple pregnancies and increased pregnancy complications compared to singleton pregnancies, highlight the need for research on this topic. Therefore, this study aimed to compare obstetrical and neonatal outcomes of twin pregnancies after fresh embryo transfer versus FET.
METHODS: This was a retrospective single-center study.
METHODS: There were in vitro fertilization (IVF) dichorionic twin pregnancies ≥23 weeks of gestation during 2010-2022.
METHODS: This retrospective study was based on data recorded at Galilee Medical Center, a tertiary-care university-affiliated hospital, Israel.
METHODS: We conducted a comparative analysis of obstetrical and neonatal outcomes between IVF dichorionic twin pregnancies after fresh embryo transfer and those after FET. This analysis included variables such as gestational age at delivery, birthweight, preterm birth rates, low birthweight rates, neonatal intensive care unit admissions, and complications related to prematurity.
RESULTS: The study included 389 IVF twin pregnancies: 253 after fresh embryo transfer and 136 after FET. Following fresh embryo transfer compared to FET, the mean gestational age at delivery was earlier (34 + 6 vs. 35 + 5 weeks, p = 0.001) and the rate of preterm birth (<37 weeks) was higher (70.4% vs. 53.7%, p = 0.001). This difference in gestational age at delivery remained significant after adjustment for maternal age, parity, and BMI (OR = 2.11, 95% CI: 2.11-3.27, p = 0.001). Similarly, the difference in preterm birth rates remained significant after adjustment of the same variables (p = 0.001). For the fresh embryo transfer compared to the FET group, the mean birthweight was lower (2,179.72 vs. 2,353.35 g, p = 0.003); and low birthweight and very low birthweight rates were higher (71.2% vs. 56.3%, p < 0.001 and 13.5% vs. 6.7%, p = 0.004, respectively). For the fresh embryo transfer compared to the FET group, the proportions were higher of neonates admitted to the neonatal intensive care unit (23.3% vs. 16.0%, p = 0.019), of neonates with respiratory distress syndrome (10.5% vs. 5.9%, p = 0.045) and those needing phototherapy (23.3% vs. 16.0%, p = 0.019).
CONCLUSIONS: Limitations of the study include its retrospective nature. Furthermore, we were unable to adjust for some confounders, such as the number of eggs retrieved, the number of embryos transferred, and methods for ovarian stimulation or preparation of the endometrium for embryo transfer.
CONCLUSIONS: Obstetrical and neonatal outcomes of twin pregnancies were worse after fresh embryo transfer than after FET. The findings support favorable fetal outcomes after FET and support the current trend of shifting from fresh embryo transfer to FET. Prospective studies are needed to support our results.