目的 探讨卵巢反应不良（POR）患者在移植不同胚胎质量时的最佳移植策略。 方法 回顾性分析2018年1月~2024年5月中山大学附属第三医院生殖中心采用拮抗剂方案促排卵，POR患者获卵数≤3个的IVF/ICSI周期共411例。其中，新鲜移植组（A组）234例，冷冻移植组（B组）177例，均为第3天（D3）卵裂期胚胎移植。按移植胚胎质量进一步分为优质胚胎组（A1组95例、B1组50例）、优质+非优质胚胎组（A2组54例、B2组74例）以及非优质胚胎组（A3组85例、B3组53例）。比较各组基础资料和妊娠率、活产率等临床妊娠结局。 结果 优质胚胎移植组，优质+非优质胚胎组中，新鲜移植和冷冻移植的临床妊娠率、种植率、活产率、流产率等均没有统计学差异。非优质胚胎移植中，冷冻移植组的临床妊娠率显著高于新鲜移植组（30.19% vs.14.12%, P=0.022），冷冻移植组种植率较新鲜移植组高（22.33% vs.10.62%, P=0.009），活产率和流产率无统计学差异（P>0.05）。多因素logistic回归分析发现，非优质胚胎移植组中，新鲜或解冻胚胎移植不影响临床妊娠率。 结论 拮抗剂方案获卵数≤3的POR患者中，当移植优质胚胎时，选择新鲜胚胎移植或者解冻胚胎移植不影响妊娠结局；如移植非优质胚胎，解冻胚胎移植的临床妊娠率有更高的趋势，需增大样本量进一步分析。
Abstract
Objective To explore the optimal embryo transfer strategy for poor ovarian response (POR) patients with embryos of different quality. Methods A retrospective analysis was performed on 411 POR patients (≤3 oocytes retrieved) treated with the antagonist protocol and IVF/ICSI at the Reproductive Center of the Third Affiliated Hospital of Sun Yat-sen University from January 2018 to May 2024. Cycles were divided into fresh transfer (Group A, n=234) and frozen transfer (Group B, n=177), all with Day 3 cleavage-stage embryo transfer. Subgroups were categorized by embryo quality: good-quality embryos (A1=95, B1=50), good plus fair/poor-quality embryos (A2=54, B2=74), and fair/poor-quality embryos only (A3=85, B3=53). Baseline characteristics and clinical outcomes (pregnancy rate, implantation rate, live birth rate, miscarriage rate) were compared. Results The patients in transferring good-quality embryos or good plus fair/poor-quality embryos groups, there were no significant differences in clinical pregnancy, implantation, live birth or miscarriage rates between fresh and frozen cycles. The patients in fair/poor-quality embryos group, the clinical pregnancy rate in the frozen transfer group was significantly higher than that of the fresh transfer group (30.19% vs. 14.12%, P=0.022) and the implantation rate was also higher than that of the fresh transfer group (22.33% vs. 10.62%, P=0.009), with no significant differences in live birth or miscarriage rates (P>0.05). Multivariate logistic regression showed that transfer mode (fresh vs. frozen) was not an independent factor affecting clinical pregnancy. Conclusions For POR patients (≤3 oocytes retrieved) under the antagonist protocol, fresh and frozen transfer show comparable outcomes when good-quality embryos are available. Frozen transfer is associated with higher clinical pregnancy and implantation rates when only fair/poor-quality embryos are transferred. These findings require verification in larger-sample studies.
关键词
拮抗剂 /
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卵巢反应不良 /
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获卵数 /
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妊娠率 /
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活产率
Key words
Antagonist protocol /
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Poor ovarian response (POR) /
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Number of oocytes retrieved /
Pregnancy rate /
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Live birth rate
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