Department of Reproductive Center, Obstetrics and Gynecology, the Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Front Endocrinol (Lausanne). 2023 Jun 19;14:1141605. doi: 10.3389/fendo.2023.1141605. eCollection 2023.
To compare the effects of five different frozen-thaw embryo transfer (FET) strategies in women aged 35-40 years.
Data from 1,060 patients were divided into five groups according to the number and quality of transferred blastocysts: a high-quality single blastocyst group (group A, n= 303), a high-quality double blastocysts group (group B, n= 176), a high-quality plus poor-quality double blastocysts group (group C, n= 273), a poor-quality double blastocysts group (group D, n= 189), and a poor-quality single blastocyst group (group E, n= 119). Comparative analyses were then performed between groups with regard to primary conditions, pregnancy, and neonatal outcomes.
Group A had the lowest twin pregnancy rate (1.97%) and incidence of low-birth-weight infants (3.45%), which were significantly different from groups B, C, and D. In addition, the preterm birth rate (7.89%), neonatal birth weight (3300 g [3000, 3637.5]), and neonatal birth age (39.14 weeks [38.43, 39.61]) in group A were different from those in groups B and C. Double blastocyst transfer (DBT) was associated with a 20.558-fold (Risk Ratio [RR]=20.558, 95% confidence interval [CI], 6.628-63.763) and 3.091-fold (RR=3.091, 95% CI, 1.69-5.653) increased risk of twin pregnancy and preterm delivery in unadjusted analysis, respectively, when compared with single blastocyst transfer (SBT). In the adjusted analysis, we observed similar risk estimates (adjusted RR=26.501, 95% CI, 8.503-82.592; adjusted RR=3.586, 95% CI, 1.899-6.769).
Although, high-quality SBT resulted in a lower live birth rate than high-quality DBT, it also significantly reduced the risk of adverse pregnancies, thus resulting in more benefits for both the mother and baby. Collectively, our data indicate that high-quality SBT remains the optimal FET strategy for women aged 35-40 years and warrants further clinical application.
比较 35-40 岁年龄段女性采用 5 种不同冷冻胚胎移植（FET）策略的效果。
根据移植的囊胚数量和质量，将 1060 例患者分为 5 组：高质量单个囊胚组（A 组，n=303）、高质量双囊胚组（B 组，n=176）、高质量+低质量双囊胚组（C 组，n=273）、低质量双囊胚组（D 组，n=189）和低质量单个囊胚组（E 组，n=119）。比较各组患者的主要情况、妊娠和新生儿结局。
A 组的双胞胎妊娠率（1.97%）和低出生体重儿发生率（3.45%）最低，与 B、C 和 D 组差异有统计学意义。此外，A 组的早产率（7.89%）、新生儿出生体重（3300 g [3000，3637.5]）和新生儿出生年龄（39.14 周 [38.43，39.61]）与 B 和 C 组不同。与单囊胚移植（SBT）相比，双囊胚移植（DBT）分别使双胞胎妊娠和早产的风险增加 20.558 倍（风险比[RR]=20.558，95%置信区间[CI]：6.628-63.763）和 3.091 倍（RR=3.091，95% CI：1.69-5.653），未经调整分析。在调整分析中，我们观察到相似的风险估计值（调整后的 RR=26.501，95% CI：8.503-82.592；调整后的 RR=3.586，95% CI：1.899-6.769）。
尽管高质量 SBT 的活产率低于高质量 DBT，但也显著降低了不良妊娠的风险，从而为母婴带来了更多益处。综上所述，我们的数据表明，对于 35-40 岁的女性，高质量 SBT 仍然是最佳的 FET 策略，值得进一步临床应用。
