目的 探讨子宫内膜异位症(EMs)患者行IVF-ET助孕时鲜胚移植及冻融胚胎移植(FET)的妊娠结局。方法 回顾性分析2017年1月至2021年12月于邢台不孕不育专科医院生殖医学中心因EMs不孕行IVF/ICSI-ET助孕患者的临床资料(共552个周期)，根据移植周期不同分为:鲜胚移植组(新鲜胚胎移植周期242个)和FET组(全胚冷冻后FET周期310个)。又根据EMs分期分为Ⅰ～Ⅱ期亚组(鲜胚移植组中190个，FET组中222个)和Ⅲ～Ⅳ期亚组(鲜胚移植组中52个，FET组中88个)。比较各组患者的一般资料、胚胎实验室指标及妊娠结局。结果 鲜胚移植组和FET组患者的不孕年限、体质量指数(BMI)、抗苗勒管激素(AMH)水平比较均无统计学差异(P＞0。05)。鲜胚移植组的内膜厚度显著高于FET组，平均年龄显著低于FET组(P均＜0。05)。鲜胚移植组的移植胚胎数显著高于FET组(P＜0。05)，鲜胚移植组中EMs分期Ⅰ～Ⅱ期患者的移植胚胎数显著高于FET组Ⅰ～Ⅱ期患者(P＜0。05);FET组中EMs分期Ⅰ～Ⅱ期患者行降调节人工周期内膜准备方案比例显著低于Ⅲ～Ⅳ期患者(P＜0。05)。鲜胚移植组的临床妊娠率、种植率、宫外孕率、流产率及活产率与FET组均无显著性差异(P＞0。05)，鲜胚移植组中Ⅲ～Ⅳ期患者的临床妊娠率(44。23％vs。68。18％)、种植率(31。68％vs。48。17％)及活产率(36。54％vs。55。68％)显著低于FET组Ⅲ～Ⅳ期患者(P＜0。05);鲜胚移植组的囊胚妊娠率显著低于FET组(53。64％vs。64。53％，P＜0。05);鲜胚移植组中Ⅲ～Ⅳ期患者的卵裂胚妊娠率(17。65％vs。59。18％)、卵裂胚种植率(12。50％vs。40。43％)、囊胚妊娠率(57。14％vs。79。49％)及囊胚种植率(40。58％vs。58。57％)显著低于 FET 组中 Ⅲ～Ⅳ期患者(P＜0。05)。结论 EMs分期Ⅲ～Ⅳ期患者行FET的临床妊娠结局优于鲜胚移植，建议此类患者可采用全胚冷冻后再择期行FET。
Comparison of clinical outcomes between fresh and freeze-thaw embryo transplantation in endometriosis
Objective:To explore the pregnancy outcomes of fresh embryo transfer and freeze-thaw embryo transfer(FET)in patients with endometriosis(EMs)undergoing in vitro fertilization or intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET)treatment.Methods:A retrospective analysis was conducted on the clinical data of 552 cycles of IVF/ICSI-ET treatment in patients with endometriosis-associated infertility at the Reproductive Medicine Center of Xingtai Infertility Hospital from January 2017 to December 2021.They were divided into two groups based on different transplantation cycles:fresh embryo transplantation group(242 cycles)and FET group(310 cycles after whole embryo cryopreservation).According to the staging of EMs,they were further divided into stages Ⅰ-Ⅱ subgroups(190 in the fresh embryo transfer group and 222 in the FET group)and Ⅲ-Ⅳsubgroups(52 in the fresh embryo transfer group and 88 in the FET group).The general information,laboratory test indicators of embryo,and pregnancy outcomes of each group were compared.Results:There were no statistically significant differences in the infertility duration,body mass index(BMI),and levels of anti Mullerian hormone(AMH)between the fresh embryo transfer group and the FET group(P＞0.05).The endometrial thickness of the fresh embryo transfer group was significantly higher than that of the FET group,while the average age was significantly lower than that of the FET group(P＜0.05).The number of transplanted embryos in the fresh embryo transfer group was significantly higher than that in the FET group(P＜0.05).In the fresh embryo transfer group,the number of transplanted embryos in EMs stage Ⅱ-Ⅱ patients was significantly higher than that in EMs stage Ⅰ-Ⅱ patients of FET group(P＜0.05).The proportion of EMs stage Ⅱ-Ⅲ patients in the FET group who underwent endometrial preparation with down-regulation protocol was significantly lower than that of EMs stageⅢ-Ⅳ patients(P＜0.05).The clinical pregnancy rate,implantation rate,ectopic pregnancy rate,miscarriage rate,and live birth rate of the fresh embryo transfer group were not significantly different from those of the FET group(P＞0.05).The clinical pregnancy rate(44.23％vs.68.18％),implantation rate(31.68％vs.48.17％),and live birth rate(36.54％vs.55.68％)of EMs stage m-Ⅳ patients in the fresh embryo transfer group were significantly lower than those in the FET group(P＜0.05).The blastocyst pregnancy rate in the fresh embryo transfer group was significantly lower than that in the FET group(53.64％vs.64.53％,P＜0.05).The cleavage embryo pregnancy rate(17.65％vs.59.18％),cleavage embryo implantation rate(12.50％vs.40.43％),blastocyst pregnancy rate(57.14％vs.79.49％),and blastocyst implantation rate(40.58％vs.58.57％)of EMs stage Ⅲ-Ⅳ patients in the fresh embryo transfer group were significantly lower than those in the FET group(P＜0.05).Conclusions:The clinical pregnancy outcomes of FET are better than those of fresh embryo transfer in patients with stage Ⅲ-Ⅳ endometriosis.It is recommended that the patients undergo FET at a later stage after whole embryo freezing.
万方数据
维普
