Zhu Jinliang, Lian Ying, Li Ming, Chen Lixue, Liu Ping, Qiao Jie
Reproductive Medical Center, Department of Obstetrics and Gynecology, Peking University Third Hospital, No. 49 North Huayuan Road, 100191, Haidian District, Beijing, China.
J Assist Reprod Genet. 2014 Dec;31(12):1635-41. doi: 10.1007/s10815-014-0351-8. Epub 2014 Oct 18.
Embryo quality is associated with successful implantation and live births. Our retrospective study was carried out to determine whether or not cleavage stage embryo quality affects the miscarriage rate, pregnancy complications and neonatal outcomes of singletons conceived with assisted reproduction technology.
The current study included 11,721 In Vitro Fertilization-Embryo Transfer cycles (IVF-ET) between January 2009 (the date at which electronic medical records were implemented at our center) and March 2013. Only women < 40 years of age undergoing their first fresh embryo transfer cycle using non-donor oocytes were included.
Our study indicated that the transfer of poor-quality embryos resulted in higher miscarriage (19.77% vs. 13.28%, p = 0.02) and lower ongoing pregnancy rates (15.33% vs. 48.06%, p < 0.001). Logistic regression analysis performed on data derived from 744 cycles culminating in miscarriages versus 4,333 cycles culminating in live births, suggested that embryo quality (p = 0.04) is significantly associated with miscarriage rate after adjusting for other confounding factors. Moreover, there were no differences in the mean birth weight, low birth weight (<2,500 g), very low birth weight (<1,500 g), gestational age, preterm delivery (<37 weeks), very preterm delivery (<32 weeks), congenital malformations, small-for-gestational-age singletons (SGA), and large-for-gestational-age singleton (LGA) rate (p > 0.05). Similarly, pregnancy complications resulting from poor-quality embryos were not different from good-quality embryos (4.04% vs. 2.57 %, p = 0.33). Finally, logistic regression suggested that embryo quality was not significantly associated with pregnancy complications after adjusting for other confounding factors (p = 0.40).
Our study suggests that transfer of poor-quality embryos did not increase the risk of adverse outcomes; however, the quality of cleavage stage embryos significantly affected the miscarriage rate and ongoing pregnancies.
胚胎质量与成功着床及活产相关。我们开展了一项回顾性研究，以确定卵裂期胚胎质量是否会影响辅助生殖技术受孕的单胎妊娠的流产率、妊娠并发症及新生儿结局。
本研究纳入了2009年1月（我院开始实施电子病历的时间）至2013年3月期间的11721个体外受精-胚胎移植周期（IVF-ET）。仅纳入年龄小于40岁、首次使用非供体卵母细胞进行新鲜胚胎移植周期的女性。
我们的研究表明，移植质量差的胚胎会导致更高的流产率（19.77%对13.28%，p = 0.02）和更低的持续妊娠率（15.33%对48.06%，p < 0.001）。对744个以流产告终的周期和4333个以活产告终的周期的数据进行逻辑回归分析，结果显示，在调整其他混杂因素后，胚胎质量（p = 0.04）与流产率显著相关。此外，平均出生体重、低出生体重（<2500克）、极低出生体重（<1500克）、孕周、早产（<37周）、极早产（<32周）、先天性畸形、小于胎龄单胎（SGA）及大于胎龄单胎（LGA）率均无差异（p > 0.05）。同样，质量差的胚胎导致的妊娠并发症与质量好的胚胎并无差异（4.04%对2.57%，p = 0.33）。最后，逻辑回归分析表明，在调整其他混杂因素后，胚胎质量与妊娠并发症无显著相关性（p = 0.40）。
我们的研究表明，移植质量差的胚胎不会增加不良结局的风险；然而，卵裂期胚胎的质量会显著影响流产率和持续妊娠情况。
