D6 期冻融胚胎移植应避免：一项回顾性队列研究。
D6 blastocyst transfer on day 6 in frozen-thawed cycles should be avoided: a retrospective cohort study.
机构信息
Reproductive Medicine Center, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, No.18 Daoshan Road, Fujian Province, 350001, Fuzhou City, China.
出版信息
BMC Pregnancy Childbirth. 2020 Sep 7;20(1):519. doi: 10.1186/s12884-020-03224-z.
BACKGROUND
There is no definitive evidence about the suitable timing to transfer blastocysts formed and cryopreserved on day 6 (D6 blastocysts) in frozen-thawed embryo transfer (FET) cycles. This study aimed to investigate the suitable timing to transfer D6 blastocysts in FET cycles and to identify factors affecting clinical pregnancy rate (CPR) and early miscarriage rate (EMR) in FET cycles with blastocysts.
METHODS
This retrospective cohort study included 1788 FET cycles with blastocysts. There were 518 cycles with D6 blastocysts, and 1270 cycles with blastocysts formed and cryopreserved on day 5 (D5 blastocysts) (D5 group). According to the blastocyst transfer timing, the cycles with D6 blastocysts were divided into cycles with D6 blastocysts transferred on day 5 (D6-on-D5 group, 103 cycles) and cycles with D6 blastocysts transferred on day 6 (D6-on-D6 group, 415 cycles). The chi-square test, independent t-test or Mann-Whitney test, and logistic regression analysis were used for data analysis.
RESULTS
The CPR and implantation rate (IR) were significantly higher in the D6-on-D5 group than in the D6-on-D6 group (55.3% vs. 37.3%, 44.8% vs. 32.6%, P < 0.01). The CPR and IR were significantly higher in the D5 group than in the D6-on-D5 group (66.0% vs. 55.3%, 62.1% vs. 44.8%, P < 0.05), and the EMR was significantly lower in the D5 group than in the D6-on-D5 group (11.2% vs. 21.1%, P < 0.05). Logistic regression analysis demonstrated that transfer D6 blastocysts on day 5, instead of day 6, could significantly increase the CPR (odds ratio[OR]: 2.031, 95% confidence interval (CI): 1.296-3.182, P = 0.002). FET cycles with D6 blastocysts transferred on day 5 had a higher EMR than those with D5 blastocysts (OR: 2.165, 95% CI: 1.040-4.506, P = 0.039). Hormone replacement therapy (HRT) cycles exhibited a higher EMR than natural cycles (OR: 1.953, 95% CI: 1.254-3.043, P = 0.003), while no difference was observed in the CPR (P > 0.05).
CONCLUSIONS
These results indicate that the suitable timing to transfer D6 blastocysts in FET cycles may be day 5, and D6 blastocyst transfer on day 6 in FET cycles should be avoided. D6 blastocysts transfer and HRT cycles may be associated with a higher EMR.
背景
目前尚无明确证据表明在冷冻胚胎移植（FET）周期中，第 6 天（D6）形成的囊胚进行冷冻保存的合适时机。本研究旨在探讨 FET 周期中 D6 囊胚移植的合适时机，并确定影响囊胚 FET 周期临床妊娠率（CPR）和早期流产率（EMR）的因素。
方法
这是一项回顾性队列研究，纳入了 1788 个囊胚 FET 周期。其中 518 个周期为 D6 囊胚，1270 个周期为第 5 天（D5）形成和冷冻保存的囊胚（D5 组）。根据囊胚移植时间，D6 囊胚周期分为 D6 囊胚于第 5 天移植的周期（D6-on-D5 组，103 个周期）和 D6 囊胚于第 6 天移植的周期（D6-on-D6 组，415 个周期）。采用卡方检验、独立 t 检验或曼-惠特尼检验和 logistic 回归分析进行数据分析。
结果
D6-on-D5 组的 CPR 和着床率（IR）明显高于 D6-on-D6 组（55.3% vs. 37.3%，44.8% vs. 32.6%，P<0.01）。D5 组的 CPR 和 IR 明显高于 D6-on-D5 组（66.0% vs. 55.3%，62.1% vs. 44.8%，P<0.05），D6-on-D5 组的 EMR 明显低于 D5 组（11.2% vs. 21.1%，P<0.05）。logistic 回归分析表明，D6 囊胚于第 5 天而不是第 6 天移植可显著提高 CPR（比值比[OR]：2.031，95%置信区间[CI]：1.296-3.182，P=0.002）。D6 囊胚于第 5 天移植的 FET 周期 EMR 高于 D5 囊胚（OR：2.165，95%CI：1.040-4.506，P=0.039）。激素替代疗法（HRT）周期的 EMR 高于自然周期（OR：1.953，95%CI：1.254-3.043，P=0.003），但 CPR 无差异（P>0.05）。
结论
这些结果表明，FET 周期中 D6 囊胚移植的合适时机可能是第 5 天，FET 周期中应避免 D6 囊胚于第 6 天移植。D6 囊胚移植和 HRT 周期可能与较高的 EMR 相关。
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