目的 对比拮抗剂方案中行卵裂期和囊胚期新鲜胚胎移植的临床结局。 方法 回顾性分析1249例患者行拮抗剂方案新鲜胚胎移植的临床资料，其中卵裂期胚胎移植周期871例，囊胚移植周期378例。 结果 两组患者的年龄、不孕年限、BMI无统计学差异（P>0.05），卵裂胚移植组的基础FSH、Gn用量、扳机日促卵泡生成素（FSH）高于囊胚移植组，基础黄体生成素（LH）、抗缪勒管激素、基础窦卵泡数、扳机日E2、P低于囊胚移植组，差异有统计学意义（P<0.05）。卵裂胚移植组的获卵数、成熟卵子数、优质胚胎数均显著低于囊胚组，差异有统计学意义（P<0.05）。卵裂胚移植组的移植胚胎数、多胎妊娠率显著高于囊胚移植组，着床率显著低于囊胚移植组，差异有统计学意义（P<0.05）；两组的临床妊娠率、早期流产率、异位妊娠率、活产率、中重度卵巢过度刺激综合征发生率、妊娠期糖尿病发生率、妊娠期高血压疾病发生率、单胎出生体重差异无统计学意义（P>0.05）。 结论 拮抗剂方案新鲜囊胚移植在不降低临床妊娠率的同时，可降低多胎妊娠率，亦可获得较好的临床结局。
Abstract
Objective To compare the clinical outcomes of fresh cleavage embryo transfer and blastocyst transfer in the gonadotropin-releasing hormone (GnRH) antagonist protocol. Methods The clinical data of 1249 women undergoing GnRH antagonist protocol cycle were retrospectively analyzed, including 871 cases of fresh cleavage embryo transfer and 378 cases of fresh blastocyst transfer. Results There was no significant difference in age, duration of infertility and BMI between the two group (P>0.05). The baseline FSH, total dosage of Gn and FSH level on trigger day in cleavage embryo transfer group were significantly higher than those in blastocyst transfer group (P<0.05). The baseline LH, AMH, AFC and E2, P level on trigger day in cleavage embryo transfer group were significantly lower than those in blastocyst transfer group (P<0.05). The total number of oocytes retrieved, matured oocyte, high-quality embryos in cleavage embryo transfer group were significantly lower than those in blastocyst transfer group, with significant difference (P<0.05). The number of embryos transfer and the multiple pregnancy rate in cleavage embryo transfer group was significantly higher than those in blastocyst transfer group, the implantation rate in cleavage embryo transfer group were significantly lower than that in blastocyst transfer group, with significant difference (P<0.05). There was no significant difference in the clinical pregnancy rate, miscarriage rate, ectopic pregnancy rate, live birth rate, the incidence of moderate-severe OHSS, GDM and hypertensive disorder complicating pregnancy and the singleton birth weight between the two groups (P>0.05). Conclusions In the GnRH antagonist protocol cycle, fresh blastocyst transfer can reduce the multiple pregnancy rate and achieve good clinical outcome.
关键词
拮抗剂方案 /
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新鲜胚胎移植 /
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卵裂期胚胎移植 /
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囊胚移植
Key words
GnRH antagonist protocol /
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Fresh embryo transfer /
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Cleavage embryo transfer /
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Blastocyst transfer
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