Reproductive Medicine Center, Xiamen University Affiliated Chenggong Hospital, Wenyuan Road No.94, Siming District, Xiamen, Fujian, 361001, People's Republic of China.
Reprod Biol Endocrinol. 2020 Sep 30;18(1):97. doi: 10.1186/s12958-020-00656-2.
While single embryo transfer (SET) is widely advocated, double embryo transfer (DET) remains preferable in clinical practice to improve IVF success rate, especially in poor prognosis patients with only poor quality embryos (PQEs) available in addition to one or no good quality embryos (GQEs). Furthermore, previous studies suggest PQE might adversely affect the implantation of a GQE when transferred together. This study aims to evaluate the effect of transferring an additional PQE with a GQE on the outcomes in poor prognosis patients.
A total of 5037 frozen-thawed blastocyst transfer (FBT) cycles between January 2012 and May 2019 were included. Propensity score matching was applied to control for potential confounders, and we used generalized estimating equations (GEE) models to identify the association between the effect of an additional PQE and the outcomes.
Overall, transferring a PQE with GQE (Group GP) achieved significantly higher pregnancy rate (PR), live birth rate (LBR) and multiple pregnancy rate (MPR) than GQE only (group G). The addition of a PQE increased LBR in patients aged 35 and over and in patients who received over 3 cycles of embryo transfer (ET) (48.1% vs 27.2%, OR:2.56, 95% CI: 1.3-5.03 and 46.6% vs 35.4%, OR:1.6, 95% CI: 1.09-2.35), but not in women under 35 and in women who received less than 3 cycles of ET (48.7% vs 43.9%, OR:1.22, 95% CI: 0.93-1.59 and 48.3% vs 41.4%, OR:1.33, 95% CI: 0.96-1.85). Group GP resulted in significantly higher MPR than group G irrespective of age and the number of previous IVF cycles.
An additional PQE does not negatively affect the implantation potential of the co-transferred GQE. Nevertheless, the addition of a PQE contributes to both live birth and multiple birth in poor prognosis patients. Physicians should still balance the benefits and risks of DET.
虽然单胚胎移植（SET）被广泛提倡，但在临床实践中，双胚胎移植（DET）仍然更可取，以提高体外受精成功率，尤其是在预后较差的患者中，除了一个或没有优质胚胎（GQE）外，只有质量较差的胚胎（PQE）可用。此外，先前的研究表明，当一起转移时，PQE 可能会对 GQE 的着床产生不利影响。本研究旨在评估在预后较差的患者中，与仅转移 GQE 相比，同时转移额外的 PQE 对结局的影响。
纳入了 2012 年 1 月至 2019 年 5 月期间的 5037 个冷冻胚胎移植（FBT）周期。采用倾向评分匹配法控制潜在混杂因素，并使用广义估计方程（GEE）模型来确定额外 PQE 对结局的影响。
总体而言，与仅转移 GQE（G 组）相比，同时转移 PQE 和 GQE（GP 组）的妊娠率（PR）、活产率（LBR）和多胎妊娠率（MPR）显著更高。在年龄 35 岁及以上的患者和接受超过 3 个胚胎移植（ET）周期的患者中，添加 PQE 可提高 LBR（48.1%比 27.2%，OR：2.56，95%CI：1.3-5.03 和 46.6%比 35.4%，OR：1.6，95%CI：1.09-2.35），但在年龄小于 35 岁的患者和接受少于 3 个 ET 周期的患者中，添加 PQE 并不能提高 LBR（48.7%比 43.9%，OR：1.22，95%CI：0.93-1.59 和 48.3%比 41.4%，OR：1.33，95%CI：0.96-1.85）。GP 组的 MPR 显著高于 G 组，与年龄和之前的 IVF 周期数无关。
额外的 PQE 不会对共同转移的 GQE 的植入潜力产生负面影响。然而，在预后较差的患者中，添加 PQE 有助于活产和多胎妊娠。医生仍应权衡 DET 的利弊。
