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新鲜囊胚和从解冻卵裂胚胎培养的囊胚移植后围产结局更好:一项基于人群的研究。

Better perinatal outcomes following transfer of fresh blastocysts and blastocysts cultured from thawed cleavage embryos: a population-based study.

机构信息

Perinatal and Reproductive Epidemiology Research Unit, School Women's and Children's Health, University of New South Wales, Level 2, McNevin Dickson Building, Randwick Hospitals Campus, Randwick, NSW 2031, Australia.

出版信息

Hum Reprod. 2010 Jun;25(6):1536-42. doi: 10.1093/humrep/deq067. Epub 2010 Mar 31.

Abstract

BACKGROUND

Fresh embryo transfer results in higher live birth rates, while thawed embryo transfer appears to result in healthier babies. This study aims to investigate the association between the transfer of fresh or thawed embryos at the cleavage or blastocyst stage and the perinatal outcomes.

METHODS

This analysis is a retrospective population-based study of 150 376 autologous embryo transfer cycles in Australia during 2002-2006. The rates of pregnancy, live delivery and 'healthy baby' delivery (a single baby born live at term, weighing >or=2500 g, surviving for at least 28 days post birth and not having congenital anomalies) were compared after transfer of fresh cleavage embryos, fresh blastocysts, thawed cleavage embryos, blastocysts from thawed cleavage embryos and thawed blastocysts.

RESULTS

The live delivery rate was significantly higher for transfer of fresh blastocysts (27.9%) than for blastocysts cultured from thawed cleavage embryos (22.0%), fresh cleavage embryos (21.7%), thawed blastocysts (16.3%) and thawed cleavage embryos (15.2%). Compared with the transfer of fresh blastocysts, the likelihood of a 'healthy baby' was significantly lower for blastocysts from thawed cleavage embryos [adjusted odds ratios (AOR) 0.73, 95% confidence intervals (CI) 0.65-0.82], fresh cleavage embryos (AOR 0.67, 95% CI 0.64-0.69), thawed blastocysts (AOR 0.57, 95% CI 0.53-0.62) and thawed cleavage embryos (AOR 0.53, 95% CI 0.51-0.56). Of thaw cycles, transfers of thawed blastocysts (AOR 0.79, 95% CI 0.70-0.89) and thawed cleavage embryos (AOR 0.71, 95% CI 0.63-0.79) had significantly lower odds of 'healthy baby' than transfer of blastocysts from thawed cleavage embryos.

CONCLUSIONS

These data suggest that an optimum practice model to maximize the outcomes of the birth of a 'healthy baby' is the transfer of blastocysts and the freezing of cleavage embryos in fresh cycles and subsequent transfer of blastocysts cultured from these thawed cleavage embryos.

摘要

背景

新鲜胚胎移植可提高活产率,而解冻胚胎移植似乎可生出更健康的婴儿。本研究旨在探究卵裂期或囊胚期新鲜胚胎与解冻胚胎移植与围产结局的关联。

方法

这是一项澳大利亚 2002-2006 年期间 150376 例自体胚胎移植周期的回顾性基于人群的研究。比较新鲜卵裂期胚胎、新鲜囊胚、解冻卵裂期胚胎、解冻卵裂期胚胎培养的囊胚和解冻囊胚移植后的妊娠率、活产率和“健康婴儿”(足月出生、体重大于或等于 2500g、出生后至少存活 28 天且无先天畸形的单胎活婴)分娩率。

结果

新鲜囊胚移植的活产率(27.9%)显著高于解冻卵裂期胚胎培养的囊胚(22.0%)、新鲜卵裂期胚胎(21.7%)、解冻囊胚(16.3%)和解冻卵裂期胚胎(15.2%)。与新鲜囊胚移植相比,解冻卵裂期胚胎培养的囊胚(调整后的优势比(AOR)0.73,95%置信区间(CI)0.65-0.82)、新鲜卵裂期胚胎(AOR 0.67,95%CI 0.64-0.69)、解冻囊胚(AOR 0.57,95%CI 0.53-0.62)和解冻卵裂期胚胎(AOR 0.53,95%CI 0.51-0.56)的“健康婴儿”可能性显著降低。在解冻周期中,解冻囊胚(AOR 0.79,95%CI 0.70-0.89)和解冻卵裂期胚胎(AOR 0.71,95%CI 0.63-0.79)的“健康婴儿”可能性显著低于解冻卵裂期胚胎培养的囊胚。

结论

这些数据表明,最大限度提高“健康婴儿”出生率的最佳实践模式是在新鲜周期中移植囊胚和冷冻卵裂期胚胎,并随后移植解冻卵裂期胚胎培养的囊胚。

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