Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Division of Reproductive Sciences & Women's Health Research, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Fertil Steril. 2022 Oct;118(4):715-723. doi: 10.1016/j.fertnstert.2022.06.017. Epub 2022 Aug 5.
To determine if morphologically suboptimal embryo quality is associated with adverse perinatal outcomes.
A retrospective cohort.
SART CORS database.
PATIENT(S): Singletons conceived from autologous in vitro fertilization fresh cycles.
INTERVENTION(S): None.
MAIN OUTCOME MEASURE(S): Birth weight (gram), birth weight z-score, low birth weight (LBW), small for gestational age (SGA), and large for gestational age (LGA).
RESULT(S): Among 5,869 in vitro fertilization fresh cycles, 71.1% transferred morphologically good embryos, and 27.0% and 1.9% transferred fair and poor embryo(s), respectively. Compared with singletons conceived from good embryos, singletons from poor embryos had a higher birth weight (3,415.8 ± 562.0 vs. 3,202.7 ± 639.9). Proportions of LBW, SGA, and LGA were comparable across embryo quality groups. Multivariate regression analysis comparing perinatal outcomes from fair vs. good embryos showed no association for birth weight (0.69-gram difference; 95% CI, -24.30-25.68), birth weight z-score (Coefficient, 0.00; 95% CI, -0.07-0.08), LBW (adjusted odds ratio [aOR], 0.84; 95% CI, 0.63-1.11), SGA (aOR, 0.93; 95% CI, 0.78-1.11), and LGA (aOR, 1.07; 95% CI, 0.86-1.33). Stratified analysis, considering cleaved and blastocyst embryo transfers separately, confirmed these findings. Sensitivity analysis revealed increased odds of LGA (aOR, 1.53; 95% CI, 1.04-2.24) with fair-quality embryos only among single embryo transfer cycles.
CONCLUSION(S): Once a singleton live birth from fresh embryo transfer is achieved, fair morphological embryo quality is not associated with a reduction in birth weight or increased risks of LBW, SGA, and LGA.
确定形态学上不太理想的胚胎质量是否与不良围产期结局有关。
回顾性队列研究。
SART CORS 数据库。
接受自体体外受精新鲜周期的单胎妊娠。
无。
出生体重（克）、出生体重 z 评分、低出生体重（LBW）、小于胎龄儿（SGA）和大于胎龄儿（LGA）。
在 5869 例体外受精新鲜周期中，71.1%移植了形态良好的胚胎，分别有 27.0%和 1.9%移植了一般和较差的胚胎。与良好胚胎受孕的单胎妊娠相比，较差胚胎受孕的单胎妊娠的出生体重较高（3415.8±562.0 与 3202.7±639.9）。胚胎质量组的 LBW、SGA 和 LGA 的比例相当。比较一般胚胎与良好胚胎的围产期结局的多变量回归分析显示，出生体重（差异 0.69 克；95%CI，-24.30 至 25.68）、出生体重 z 评分（系数 0.00；95%CI，-0.07 至 0.08）、LBW（调整后的比值比[aOR]，0.84；95%CI，0.63 至 1.11）、SGA（aOR，0.93；95%CI，0.78 至 1.11）和 LGA（aOR，1.07；95%CI，0.86 至 1.33）无相关性。分别考虑卵裂胚胎和囊胚移植的分层分析证实了这些发现。敏感性分析显示，只有在单胚胎移植周期中，一般质量胚胎的 LGA （aOR，1.53；95%CI，1.04 至 2.24）的可能性增加。
一旦实现了新鲜胚胎移植的单胎活产，形态学一般的胚胎质量与出生体重降低或 LBW、SGA 和 LGA 风险增加无关。
