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早期卵裂对单卵裂胚和单囊胚移植后妊娠结局及产科结局的影响
The Impact of Early Cleavage on Pregnancy and Obstetric Outcomes after Single Cleavage Stage Embryo and Single Blastocyst Transfer
【摘要】 目的:研究早期卵裂对新鲜周期单卵裂胚和单囊胚移植后妊娠结局及产科结局的影响。方法:回顾性分析2018年8月至2022年12月在本院生殖医学中心行体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)新鲜周期治疗中单卵裂胚移植的患者794例和单囊胚移植的患者1466例,根据移植的胚胎是否发生正常早期卵裂分组。在单卵裂胚移植中,正常早期卵裂组(早卵裂组)383例,无正常早期卵裂组(未早卵裂组)411例;在单囊胚移植中,早卵裂组815例,未早卵裂组651例。比较早卵裂组和未早卵裂组在单卵裂胚移植和单囊胚移植中的妊娠结局及产科结局。结果:在单卵裂胚移植中,早卵裂组人绒毛膜促性腺激素(hCG)阳性率、临床妊娠率、活产率显著高于未早卵裂组(64.0%vs. 55.7%,P=0.018;54.6%vs. 47.0%,P=0.032;46.7%vs. 38.7%,P=0.022),生化流产率、多胎率、流产率、早期流产率、早产率、低出生体质量儿率、巨大儿率、出生缺陷率与未早卵裂组相比差异无统计学意义(P>0.05);在单囊胚移植中,早卵裂组各项妊娠指标和产科指标与未早卵裂组相比差异均无统计学意义(P>0.05)。多因素Logistic回归分析显示,校正混杂因素对妊娠结局的影响后,在单卵裂胚移植中,早卵裂有助于提高hCG阳性率[调整比值比(aOR) 1.54,95%CI 1.12~2.11,P=0.008]、临床妊娠率(aOR 1.49,95%CI 1.09~2.04,P=0.012)、活产率(aOR 1.53,95%CI 1.12~2.09,P=0.008);在单囊胚移植中,早卵裂对上述指标无显著影响(P>0.05)。结论:移植有正常早期卵裂的单卵裂胚可明显提高临床妊娠率和活产率;单囊胚移植中早期卵裂对临床妊娠结局却无明显影响。早期卵裂对单卵裂胚和单囊胚移植的产科结局无明显影响。
【Abstract】 Objective:To investigate the impact of early cleavage on the pregnancy and obstetric outcomes of fresh cycle single cleavage embryo and single blastocyst transfer.Methods:A retrospective study was conducted to analyze 794 patients who underwent single cleavage embryo transfer and 1466 patients who underwent single blastocyst transfer in the reproductive medicine center of our hospital from August 2018 to December 2022 during the fresh cycle treatment of in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET).The patients were divided into two groups according to whether the transferred embryos underwent normal early cleavage.In the single cleavage embryo transfer, there were 383 cases in the normal early cleavage group(early cleavage group) and 411 cases in the non normal early cleavage group(non-early cleavage group);in the single blastocyst transfer, there were 815 cases in the early cleavage group and 651 cases in the non-early cleavage group.The pregnancy and obstetric outcomes of the early cleavage group and non-early cleavage group were compared in single cleavage embryo transfer and single blastocyst transfer.Results:In the single cleavage embryo transfer, the human chorionic gonadotropin(hCG) positive rate, clinical pregnancy rate, and live birth rate in the early cleavage group were significantly higher than those in the non-early cleavage group(64.0% vs.55.7%,P=0.018;54.6% vs.47.0%,P=0.032;46.7% vs.38.7%,P=0.022).There were no significant differences in biochemical abortion rate, multiple pregnancy rate, abortion rate, early abortion rate, premature delivery rate, low birth weight rate, macrosomia rate, and birth defect rate compared with the non-early cleavage group(P>0.05);in the single blastocyst transfer, there were no significant differences in pregnancy outcomes and obstetric indicators between the early cleavage group and the non-early cleavage group(P>0.05).Multivariate Logistic regression analysis showed that after adjusting for confounding factors on pregnancy outcomes, in the single cleavage embryo transfer, the hCG positive rate(aOR 1.54,95%CI 1.12-2.11,P=0.008),clinical pregnancy rate(aOR 1.49,95%CI 1.09-2.04,P=0.012),and live birth rate(aOR 1.53,95%CI 1.12-2.09,P=0.008) in the early cleavage group were significantly higher than those in the non-early cleavage group; in the single blastocyst transfer, there were no significant differences for these indicators between the early cleavage group and the non-early cleavage group(P>0.05).Conclusions:Transplantation of single cleavage embryo with normal early cleavage can significantly improve the clinical pregnancy rate and live birth rate.Early cleavage during single blastocyst transplantation had no significant effect on clinical pregnancy outcome.Early cleavage had no significant effect on the obstetric outcomes of single cleavage embryo and single blastocyst transfer.
【Key words】 Early cleavage; Single cleavage embryo transfer; Single blastocyst transfer; Pregnancy outcomes; Obstetric outcomes;
- 【文献出处】 实用妇产科杂志 ,Journal of Practical Obstetrics and Gynecology , 编辑部邮箱 ,2025年02期
- 【分类号】R714.8
- 【下载频次】16