冻融囊胚移植相较于新鲜囊胚移植可降低宫外孕发生率：一项荟萃分析。
Frozen blastocyst transfer reduces incidence of ectopic pregnancy compared with fresh blastocyst transfer: a meta-analysis.
机构信息
a Reproductive Medicine Center , Guangxi Medical University First Affiliated Hospital , Nanning , China.
出版信息
Gynecol Endocrinol. 2019 Feb;35(2):93-99. doi: 10.1080/09513590.2018.1497154. Epub 2018 Aug 21.
BACKGROUND
Ectopic pregnancy (EP) is the main cause of maternal death during early pregnancy. Blastocyst transfer (BT) reduces EP rates compared with cleavage stage embryo transfer (ET), and frozen ET reduces EP rates compared with fresh ET. However, data comparing the EP rate of fresh BT and frozen BT are limited. The objective of this meta-analysis was to determine whether frozen BT decreases the EP rate compared with fresh BT.
MATERIALS AND METHODS
PUBMED, EMBASE, and Cochrane Library databases were searched for papers with no limitation on language and publication year. A systemic literature search identified 14 studies which met the inclusion criteria for further analysis. EP rate is our only outcome measure. All statistical analyses were carried out using RevMan software [version 5.3]. Random effects models were chosen to calculate the odds ratio (OR).
RESULTS
Fourteen retrospective studies (n = 251,762 cycles) were finally analyzed, including 154,214 and 97,548 cycles undergoing fresh and frozen BT, respectively. Compared with fresh BT, the frozen BT was associated with an decrease in EP rate [OR = 1.79; 95% confidence interval (CI) = 1.37-2.34, heterogeneity was 71%], the EP rate was 1.74% (2683/154,214 pregnancies) for fresh BT and 0.97% (949/97,548 pregnancies) for frozen BT. The number of embryos transferred in subgroup analysis found that the incidence of EP in frozen BT is lower than fresh BT (OR = 1.62; 95% CI = 1.38-1.91), the EP rate was 1.2% (206/16,610 pregnancies) for one fresh BT and 0.8% (153/19,569 pregnancies) for one frozen BT, also the EP rate was 1.9% (78/4043 pregnancies) for two fresh BT and 1.1% (19/1790 pregnancies) for two frozen BT.
CONCLUSIONS
Our meta-analysis found that frozen BT was associated with an decrease in EP rate compared with fresh BT in IVF/ICSI patients. We also found that a single frozen BT is the better choice as a method to reduce the incidence of EP.
背景
异位妊娠（EP）是孕早期产妇死亡的主要原因。囊胚移植（BT）与卵裂期胚胎移植（ET）相比，降低了 EP 发生率，而冷冻 ET 与新鲜 ET 相比，降低了 EP 发生率。然而，比较新鲜 BT 和冷冻 BT 的 EP 发生率的数据有限。本荟萃分析的目的是确定冷冻 BT 是否比新鲜 BT 降低 EP 发生率。
材料与方法
对 PUBMED、EMBASE 和 Cochrane 图书馆数据库进行了无语言和出版年份限制的文献检索。系统文献检索确定了 14 项符合进一步分析标准的研究。EP 发生率是我们唯一的结局指标。所有统计分析均使用 RevMan 软件[版本 5.3]进行。选择随机效应模型计算比值比（OR）。
结果
最终分析了 14 项回顾性研究（n=251762 个周期），其中新鲜 BT 和冷冻 BT 分别为 154214 个和 97548 个周期。与新鲜 BT 相比，冷冻 BT 与 EP 发生率降低相关[OR=1.79；95%置信区间（CI）=1.37-2.34，异质性为 71%]，新鲜 BT 的 EP 发生率为 1.74%（2683/154214 例妊娠），冷冻 BT 的 EP 发生率为 0.97%（949/97548 例妊娠）。胚胎移植数量的亚组分析发现，冷冻 BT 的 EP 发生率低于新鲜 BT（OR=1.62；95%CI=1.38-1.91），新鲜 BT 的 EP 发生率为 1.2%（206/16610 例妊娠），冷冻 BT 的 EP 发生率为 0.8%（153/19569 例妊娠）。新鲜 BT 移植两个胚胎的 EP 发生率为 1.9%（78/4043 例妊娠），冷冻 BT 移植两个胚胎的 EP 发生率为 1.1%（19/1790 例妊娠）。
结论
本荟萃分析发现，与新鲜 BT 相比，IVF/ICSI 患者的冷冻 BT 与 EP 发生率降低相关。我们还发现，冷冻 BT 单次移植是降低 EP 发生率的更好选择。
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