南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (7): 1050-1055.doi: 10.12122/j.issn.1673-4254.2021.07.12

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高龄不孕症患者冻融胚胎移植胚胎数目和质量与早期妊娠丢失率的关系

张庆颜，张 俊，周星宇，黎 莹，陈映雪，陈 薪，陈士岭   

  • 出版日期:2021-07-20 发布日期:2021-07-19

Association of number and quality of embryos transferred with early pregnancy loss in infertile women at an advanced age undergoing frozen-thawed embryo transfer

  • Online:2021-07-20 Published:2021-07-19

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摘要： 目的 分析高龄不孕患者接受辅助生殖技术（ART）行冻融胚胎移植（FET）周期的胚胎数目和质量与早期妊娠丢失率的关系。方法 选择2015年1月~2018年12月于南方医科大学南方医院接受ART并行FET的≥36岁的不孕症患者共2622例，对妊娠的976例患者根据后续妊娠情况分为早期妊娠丢失组和持续妊娠组，分析早期妊娠丢失率与年龄、移植胚胎数、胚胎质量等的关系；根据患者年龄分为：36~37岁组、38~39岁组、40岁组、41岁组、42岁组、43岁组、44岁组和45~48岁组，进一步分析不同年龄段早期妊娠丢失率与胚胎移植数及胚胎质量的关系。结果 本研究共纳入2622例FET周期，其中临床妊娠976例，临床妊娠率37.2%（976/2622），活产663例，活产率25.3%。临床妊娠患者中早期妊娠丢失241例，继续妊娠735例，早期妊娠丢失率24.7%（241/976）。各组患者临床妊娠率及活产率随年龄增长而降低，早期妊娠丢失率随年龄增长而显著升高（P<0.001）；早期妊娠丢失组患者FET年龄及取卵年龄均高于持续妊娠组，移植D3胚胎数高于持续妊娠组（0.97 vs 0.81，P=0.030），着床胚胎数低于持续妊娠组（1.09 vs 1.25，P<0.001）；各年龄组早期妊娠丢失率与移植胚胎数和胚胎质量没有显著关系（P>0.05）。结论 高龄不孕女性患者冻融移植胚胎周期的早期妊娠丢失率随年龄增长而升高，年龄是导致早期妊娠丢失的无法补救的危险因素，故应对高龄不孕女性尽早实施ART助孕治疗。为降低早期胚胎丢失率，同时权衡多胎妊娠的风险，根据胚胎质量谨慎决定胚胎移植数。

关键词: 辅助生殖技术；体外受精-胚胎移植；冻融胚胎移植；高龄；胚胎质量；早期妊娠丢失

Abstract: Objective To investigate the association of the number and quality of embryos transferred in frozen-thawed embryo transfer (FET) cycle with the occurrence of early pregnancy loss in infertile women at an advanced age. Methods We collected the data of a total of 2622 infertile women aged 36 years or older receiving FET between January, 2015 and December, 2018. The occurrence of early pregnancy loss was analyzed in these women, and the relation of age, the number and quality of embryos transferred with early pregnancy loss was explored in the overall cohort and in different age (36-37, 38-39, 40, 41, 42, 43, 44 and 45-48 years) groups. Results Of the 2622 women, 976 (37.2%) achieved clinical pregnancy after FET, among whom 241 (24.7%) experienced early pregnancy loss. The clinical pregnancy rate and live birth rate decreased significantly and early pregnancy loss rate increased markedly with age (P<0.001). The age at both FET and oocyte pick-up was significantly higher in early pregnancy loss group than ongoing pregnancy group. Compared with those with ongoing pregnancy, the women with early pregnancy loss had a significantly greater number of D3 embryos transferred (0.97 vs 0.81) and a lower number of implanted embryos (1.09 vs 1.25). The early pregnancy loss rates was not significantly correlated with the number and quality of embryo transferred across all the age groups. Conclusions In infertile women at an advanced age, the early pregnancy loss rate in FET cycle increases with age. An advanced age is an inherent risk factor for early pregnancy loss, therefore ART should be implemented as soon as possible for these women. To reduce early pregnancy loss rate and balance the risk of multiple pregnancies, the number of embryos transferred should be carefully determined on the basis of embryo quality.

Key words: assisted reproductive technology; in vitro fertilization-embryo transfer; frozen-thawed embryo transfer; advanced-aged women; embryo quality; early pregnancy loss