选择性单囊胚移植对瘢痕子宫患者辅助生殖治疗后妊娠结局的影响
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摘要
目的评价应用选择性单囊胚移植(elective single embryo transfer, eSET)和双囊胚移植(double-embryo transfer,DET)对瘢痕子宫患者辅助生殖治疗(assisted reproductive treatment,ART)后妊娠结局的差异。方法选取2015年1月至2016年10月间于海南医学院第一附属医院收治的110例瘢痕子宫患者作为研究对象。随机数表法分为eSET组(55例)和DET组(55例),比较两组患者治疗后临床妊娠率、足月分娩率、活产率等妊娠结局,以及早产率、死胎率和多胎率等不良妊娠结局间的差异。应用多因素Logistic回归分析探究影响瘢痕子宫患者辅助生殖不良妊娠结局的危险因素。结果 eSET组和DET组的ART治疗方式(χ~2=1.502,P=0.472)、Gn总剂量(t=-1.215,P=0.227)、Gn治疗时间(t=-1.001,P=0.319)和排卵个数(t=1.055,P=0.294)等ART治疗情况间均无统计学差异。eSET组和DET组新鲜囊胚与累计的临床妊娠率(χ~2=0.042,0.146;P=0.838,0.703)、足月分娩率(χ~2=0.000,1.387;P=1.000,0.239)和活产率(χ~2=0.530,1.477;P=0.467,0.229)间均无统计学差异。eSET组和DET组新鲜囊胚与累计的早产率(χ~2=0.042,0.440;P=0.838,0.507)和死胎率(χ~2=0.213,0.176;P=0.644,0.675)均无统计学差异,eSET组的累积多胎率(χ~2=4.407,P=0.036)和不良妊娠结局发生率活产率(χ~2=3.911,P=0.048)均显著低于DET组。Logistic回归分析显示,DET、年龄>35岁、BMI>30 kg/m2是瘢痕子宫患者辅助生殖不良妊娠结局的独立危险因素。结论在瘢痕子宫患者辅助生殖治疗中应用eSET的临床妊娠率、足月分娩率和活产率与DET相似,但能够明显降低多胎妊娠风险;高龄、高BMI是瘢痕子宫患者辅助生殖不良妊娠结局的独立危险因素。
Objective To explore the effect of elective single blastocyst transfer(eSET) and double-embryo transfer(DET) on the pregnancy outcome after assisted reproductive treatment(ART) in patients with scarred uterus. Methods A total of 110 patients with scarred uterus for ART in our hospital from January 2015 to October 2016 were randomly divided into two groups:eSET group(55 cases) and DET group(55 cases). The pregnancy rate, full-term delivery rate, live birth rate and other pregnancy outcomes, as well as preterm birth rate, stillbirth rate and multiple birth rate and other adverse pregnancy outcomes in two groups were comparatively analyzed. Multivariate Logistic regression analysis was used to explore the risk factors of adverse pregnancy outcomes. Results There was no statistically significantdifference in the ART treatments(χ~2= 1.502, P= 0.472), total Gn dose(t=-1.215, P= 0.227), Gn treatment time(t =-1.001, P= 0.319) and ovulation number(t = 1.055, P= 0.294) between eSET group and DET group. There was no statistically significantdifference in the clinical pregnancy rates(χ~2 = 0.042,0.146; P= 0.838,0.703), full term delivery rates(χ~2= 0.000,1.387; = 0.530,1.477; P= 0.467,0.229) of fresh embryos and calculation between the two groups. There was no statisticallysignificant difference in preterm birth rates(χ~2= 0.042,0.440; P= 0.838,0.507) and stillbirth rate(χ~2= 0.213,0.176, P= 0.644,0.675) between eSET group and DET group. The cumulative multiple pregnancy rate(χ~2= 3.911, P= 0.048) and adverse pregnancy outcome(χ~2= 4.407, P= 0.036) in eSET group were significantly lower than those of DET group. Logistic regression analysis showed that DET, age over 35 years old, and BMI> 30 kg/m~2 were independent risk factors for adversepregnancy outcomes after ART in patients with uterine scar. Conclusions The clinical pregnancy rate, full-term delivery rate and live birth rate of eSET in the ART of patients with uterine scar are similar to those of DET, but eSET can significantly reduce the risk of multiple pregnancies. Age> 35 years and BMI> 30 kg/m~2 are the independent risk factors of adverse pregnancy outcomes after ART in patients with uterine scar.
Objective To explore the effect of elective single blastocyst transfer(eSET) and double-embryo transfer(DET) on the pregnancy outcome after assisted reproductive treatment(ART) in patients with scarred uterus. Methods A total of 110 patients with scarred uterus for ART in our hospital from January 2015 to October 2016 were randomly divided into two groups:eSET group(55 cases) and DET group(55 cases). The pregnancy rate, full-term delivery rate, live birth rate and other pregnancy outcomes, as well as preterm birth rate, stillbirth rate and multiple birth rate and other adverse pregnancy outcomes in two groups were comparatively analyzed. Multivariate Logistic regression analysis was used to explore the risk factors of adverse pregnancy outcomes. Results There was no statistically significantdifference in the ART treatments(χ~2= 1.502, P= 0.472), total Gn dose(t=-1.215, P= 0.227), Gn treatment time(t =-1.001, P= 0.319) and ovulation number(t = 1.055, P= 0.294) between eSET group and DET group. There was no statistically significantdifference in the clinical pregnancy rates(χ~2 = 0.042,0.146; P= 0.838,0.703), full term delivery rates(χ~2= 0.000,1.387; = 0.530,1.477; P= 0.467,0.229) of fresh embryos and calculation between the two groups. There was no statisticallysignificant difference in preterm birth rates(χ~2= 0.042,0.440; P= 0.838,0.507) and stillbirth rate(χ~2= 0.213,0.176, P= 0.644,0.675) between eSET group and DET group. The cumulative multiple pregnancy rate(χ~2= 3.911, P= 0.048) and adverse pregnancy outcome(χ~2= 4.407, P= 0.036) in eSET group were significantly lower than those of DET group. Logistic regression analysis showed that DET, age over 35 years old, and BMI> 30 kg/m~2 were independent risk factors for adversepregnancy outcomes after ART in patients with uterine scar. Conclusions The clinical pregnancy rate, full-term delivery rate and live birth rate of eSET in the ART of patients with uterine scar are similar to those of DET, but eSET can significantly reduce the risk of multiple pregnancies. Age> 35 years and BMI> 30 kg/m~2 are the independent risk factors of adverse pregnancy outcomes after ART in patients with uterine scar.
引文
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[12] Eum JH,Park JK,Kim SY,et al.Clinical outcomes of single versus double blastocyst transfer in fresh and vitrified-warmed cycles[J].Clin Exp Reprod Med,2016,43(3):164-168.
[13] Lee MS,Evans BT,Stern AD,Hornstein MD.Economic implications of the society for assisted reproductive technology embryo transfer guidelines:Healthcare dollars saved by reducing iatrogenic triplets[J].Fertil Steril,2016,106(1):189-195.e3.
[14] He QH,Wang L,Liang LL,et al.Clinical outcomes of frozen-thawed single blastocyst transfer in patients requiring whole embryo freezing[J].Syst Biol Reprod Med,2016,62(2):133-138.
[15] 梁明明,唐永梅,韦立红,等.冻融移植周期中单、双囊胚及卵裂期双胚胎移植结局的临床分析[J].中国计划生育学杂志,2016,24(10):682-686.
[16] Tannus S,Cohen Y,Son WY,et al.Cumulative live birth rate following elective single blastocyst transfer compared with double blastocyst transfer in women aged 40 years and over[J].Reprod Biomed Online,2017,35(6):733-738.
[17] Naasan M,Waterstone J,Johnston MM,et al.Assisted reproductive technology treatment outcomes[J].Ir Med J,2012,105(5):136-139.
[18] Ishihara O,Araki R,Kuwahara A,et al.Impact of frozen-thawed single-blastocyst transfer on maternal and neonatal outcome:An analysis of 277,042 single-embryo transfer cycles from 2008 to 2010 in Japan[J].Fertil Steril,2014,101(1):128-133.
[19] Styer AK,Luke B,Vitek W,et al.Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States,2004-2012[J].Fertil Steril,2016,106(1):80-89.
[20] Fujimoto A,Morishima K,Harada M,et al.Elective single-embryo transfer improves cumulative pregnancy outcome in young patients but not in women of advanced reproductive age[J].J Assist Reprod Genet,2015,32(12):1773-1779.
[21] Tannus S,Son WY,Dahan MH.Elective single blastocyst transfer in advanced maternal age[J].J Assist Reprod Genet,2017,34(6):741-748.
[22] Harbottle S,Hughes C,Cutting R,et al.Elective single embryo transfer:An update to UK best practice guidelines[J].Hum Fertil (Camb),2015,18(3):165-183.
[2] Pandian Z,Marjoribanks J,Ozturk O,et al.Number of embryos for transfer following in vitro fertilisation or intra-cytoplasmic sperm injection[J].Cochrane Database Syst Rev,2013,(7):CD003416.
[3] Okun N,Sierra S.Pregnancy outcomes after assisted human reproduction[J].J Obstet Gynaecol Can,2014,36(1):64-83.
[4] 张颖,吴金香,王海滨.胚胎植入的研究进展:从基础到临床[J].中国实用妇科与产科杂志,2017,33(11):1117-1121.
[5] Performing the embryo transfer:A guideline[J].Fertil Steril,2017,107(4):882-896.
[6] 乔杰,马彩虹,刘嘉茵,等.辅助生殖促排卵药物治疗专家共识[J].生殖与避孕,2015,35(4):211-223.
[7] The Istanbul consensus workshop on embryo assessment:proceedings of an expert meeting[J].Hum Reprod,2011,26(6):1270-1283.
[8] 中华医学会生殖医学分会第一届实验室学组.人类体外受精-胚胎移植实验室操作专家共识(2016) [J].生殖医学杂志,2017,26(1):1-8.
[9] 石一复.广义认识和警惕各种瘢痕子宫[J].中国计划生育和妇产科,2017,9(1):1-3.
[10] 高翠玲.瘢痕子宫史妇女的生育结局研究[J].医学综述,2012,18(17):2935-2936.
[11] 马淳,师娟子,李明昭,等.鲜胚移植和冻融胚胎移植中单卵双胎发生的相关因素分析[J].生殖医学杂志,2016,25(12):1054-1058.
[12] Eum JH,Park JK,Kim SY,et al.Clinical outcomes of single versus double blastocyst transfer in fresh and vitrified-warmed cycles[J].Clin Exp Reprod Med,2016,43(3):164-168.
[13] Lee MS,Evans BT,Stern AD,Hornstein MD.Economic implications of the society for assisted reproductive technology embryo transfer guidelines:Healthcare dollars saved by reducing iatrogenic triplets[J].Fertil Steril,2016,106(1):189-195.e3.
[14] He QH,Wang L,Liang LL,et al.Clinical outcomes of frozen-thawed single blastocyst transfer in patients requiring whole embryo freezing[J].Syst Biol Reprod Med,2016,62(2):133-138.
[15] 梁明明,唐永梅,韦立红,等.冻融移植周期中单、双囊胚及卵裂期双胚胎移植结局的临床分析[J].中国计划生育学杂志,2016,24(10):682-686.
[16] Tannus S,Cohen Y,Son WY,et al.Cumulative live birth rate following elective single blastocyst transfer compared with double blastocyst transfer in women aged 40 years and over[J].Reprod Biomed Online,2017,35(6):733-738.
[17] Naasan M,Waterstone J,Johnston MM,et al.Assisted reproductive technology treatment outcomes[J].Ir Med J,2012,105(5):136-139.
[18] Ishihara O,Araki R,Kuwahara A,et al.Impact of frozen-thawed single-blastocyst transfer on maternal and neonatal outcome:An analysis of 277,042 single-embryo transfer cycles from 2008 to 2010 in Japan[J].Fertil Steril,2014,101(1):128-133.
[19] Styer AK,Luke B,Vitek W,et al.Factors associated with the use of elective single-embryo transfer and pregnancy outcomes in the United States,2004-2012[J].Fertil Steril,2016,106(1):80-89.
[20] Fujimoto A,Morishima K,Harada M,et al.Elective single-embryo transfer improves cumulative pregnancy outcome in young patients but not in women of advanced reproductive age[J].J Assist Reprod Genet,2015,32(12):1773-1779.
[21] Tannus S,Son WY,Dahan MH.Elective single blastocyst transfer in advanced maternal age[J].J Assist Reprod Genet,2017,34(6):741-748.
[22] Harbottle S,Hughes C,Cutting R,et al.Elective single embryo transfer:An update to UK best practice guidelines[J].Hum Fertil (Camb),2015,18(3):165-183.