【摘要】 目的 探讨选择性单囊胚移植(eSBT)在高龄(年龄≥36岁)女性首次IVF/ICSI治疗中应用的可行性及有效性。方法 回顾性分析2015年1月至2020年11月在西北妇女儿童医院生殖中心首次行IVF/ICSI治疗的年龄≥36岁、新鲜促排周期获得2枚及以上囊胚的不孕症患者的临床资料，共508例患者(508个周期),随访时间截止2021年11月30日。根据第1次新鲜周期移植囊胚数目分为eSBT组(333个周期)和双囊胚移植(DBT)组(175个周期)。比较两组患者新鲜周期妊娠结局、累积活产率、双胎率和新生儿早产、低出生体重发生率等；并按照不同女性年龄及囊胚质量对妊娠结果进行分层分析。结果 两组一般资料比较，eSBT组患者平均年龄显著小于DBT组(P<0.01),eSBT组可用囊胚数、冷冻囊胚数以及优质囊胚率均显著高于DBT组(P<0.05)。两组新鲜移植周期妊娠结局比较，eSBT组和DBT组临床妊娠率(62.8%vs. 62.3%)、活产率(48.6%vs. 50.9%)、流产率(22.5%vs. 18.3%)均无显著性差异(P>0.05);eSBT组囊胚种植率显著高于DBT组(64.9%vs. 42.9%),双胎率显著低于DBT组(3.7%vs. 25.8%)(P<0.01)。eSBT组和DBT组的累积活产率相似(70.9%vs. 62.3%,P>0.05)。不同年龄亚组中，eSBT组的累积活产率有高于DBT组的趋势，但尚无显著性差异(P>0.05);≥40岁亚组的累积活产率略低于36～<38岁、38～<40岁亚组，亦无显著性差异(P>0.05)。不同囊胚质量亚组的累计活产率无显著性差异(P>0.05)。eSBT组的累积双胎率(7.6%vs. 25.7%)、早产率(12.7%vs.28.4%)、新生儿低出生体重率(11.9%vs. 27.5%)均显著低于DBT组(P<0.05)。结论 对于年龄≥36岁且至少有2枚囊胚的患者，行eSBT可在不降低活产率的同时显著降低多胎妊娠率及新生儿不良结局风险。更多还原

【Abstract】 Objective:To explore the feasibility and effectiveness of elective single-blastocyst transfer(eSBT) in IVF/ICSI treatment among aged women(≥36 years).Methods:The clinical data were retrospectively analyzed in 508 women aged ≥36 years who received IVF/ICSI ovarian stimulation cycles(508 cycles) for the first time and obtained ≥2 blastocysts in our center from January 2015 to November 2020,and the follow-up period ended November 30,2021. According to the number of blastocysts transplanted in the first fresh cycle, the patients were divided into two groups: the eSBT group(n=333) and double blastocyst group(DBT group, n=175). The fresh-cycle pregnancy outcome, cumulative live birth rate, twinning rate, preterm birth rates and low birth weight rate were compared between the two groups. The pregnancy results were analyzed by stratification according to different female ages and blastocyst quality.Results:The women’s age were significantly younger in eSBT group than that in DBT group(P<0.01). The number of available blastocysts & frozen blastocyst and high-quality blastocyst rate in eSBT group were significantly higher than those in DBT group(P<0.05). There were no significant differences in clinical pregnancy rate(62.8% vs. 62.3%),live birth rate(48.6% vs. 50.9%) and abortion rate(22.5% vs. 18.3%) between eSBT group and DBT group(P>0.05). The implantation rate in eSBT group was significantly higher than that in DBT group(64.9% vs. 42.9%),and the twinning rate was significantly lower than that in DBT group(3.7% vs 25.8%)(P<0.01). The cumulative live birth rate was similar between the two groups(70.9% vs. 62.3%,P>0.05). In different age subgroups, the cumulative live birth rate of eSBT group was higher than that of DBT group, but there was no significant difference(P>0.05). The cumulative live birth rate of ≥40 years subgroup was slightly lower than that of 36 years to <38 years subgroup and 38 years to <40 years subgroup, but there was no significant difference(P>0.05). There was no significant difference in the cumulative live birth rate of different blastocyst quality subgroups(P>0.05). The cumulative twinning rate(7.6% vs. 25.7%),premature delivery rate(12.7% vs. 28.4%) and low birth weight rate of newborns(11.9% vs. 27.5%) in eSBT group were significantly lower than those in DBT group(P<0.05).Conclusions:In women aged ≥36 years old with at least two blastocysts, eSBT can significantly reduce the multiple pregnancy rate and the risk of adverse neonatal outcomes without reducing the cumulative live birth rate.更多还原