冻融胚胎移植周期中反复着床失败患者行序贯胚胎移植与卵裂期胚胎或囊胚双移植的比较：一项队列研究。
Sequential embryo transfer versus double cleavage-stage embryo or double blastocyst transfer in patients with recurrent implantation failure with frozen-thawed embryo transfer cycles: a cohort study.
机构信息
State Key Laboratory of Female Fertility Promotion, Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
National Clinical Research Center for Obstetrics and Gynecology Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China.
出版信息
Front Endocrinol (Lausanne). 2023 Sep 8;14:1238251. doi: 10.3389/fendo.2023.1238251. eCollection 2023.
BACKGROUND
Recurrent implantation failure (RIF) is more common among patients receiving assisted reproductive treatment. Many efforts have been made to increase the incidence of clinical pregnancy among patients with RIF. The effect of the sequential transfer procedure, a two-step interval transfer of a cleavage-stage embryo followed by a blastocyst in one transfer cycle, on the clinical outcomes of RIF patients remains controversial.
METHODS
In total, 1774 frozen-thawed embryo transfer (FET) cycles in RIF patients were included. Of these cycles, 302 were sequential embryo transfer (ET) cycles, 979 were double day 3 cleavage-stage ET cycles, and 493 were double blastocyst ET cycles. The primary outcomes were the rates of implantation, clinical pregnancy and multiple pregnancy, and the secondary outcomes were the rates of hCG positive, early miscarriage and ectopic pregnancy.
RESULTS
The implantation, hCG positive, and clinical pregnancy rates in the sequential ET group (32.1%, 58.9%, 50.7%) were significantly higher than those in the day 3 cleavage-stage ET group (24.9%, 46.5%, 40.4%) and were similar to those in the blastocyst transfer group (30.1%, 56.4%, 47.1%). The early miscarriage rate in the blastocyst transfer group was significantly higher than that in the cleavage-stage ET group (17.2% vs. 8.1%, 0.05), while the ectopic pregnancy rate in the blastocyst transfer group was significantly lower than that in the cleavage-stage ET group (0.4% vs. 3.0%, 0.05). The multiple pregnancy rate in the sequential ET group was significantly lower than that in the cleavage-stage ET group (17.0% vs. 25.5%, 0.05) and the blastocyst transfer group (17.0% vs. 27.6%, 0.05). When cycles of blastocyst culture failure were excluded, the clinical pregnancy rate was significantly higher (55.7% vs. 47.1%, 0.05), and the early miscarriage rate and multiple pregnancy rate were significantly lower (8.5% vs. 17.2%, 17.7% vs. 27.6%; 0.05, respectively) in the sequential ET group than in the double blastocyst ET group.
CONCLUSIONS
Sequential embryo transfer in FET cycles could improve the clinical outcomes of patients with RIF.
背景
在接受辅助生殖治疗的患者中，反复着床失败（RIF）更为常见。人们已经做出了许多努力来提高 RIF 患者的临床妊娠率。两步法序贯胚胎移植，即在一个移植周期中先后移植卵裂期胚胎和囊胚，对 RIF 患者的临床结局的影响仍存在争议。
方法
共纳入 1774 例 RIF 患者的冷冻胚胎解冻移植（FET）周期。其中，302 例为序贯胚胎移植（ET）周期，979 例为双日 3 天卵裂期 ET 周期，493 例为双囊胚 ET 周期。主要结局为着床率、临床妊娠率和多胎妊娠率，次要结局为血 hCG 阳性率、早期流产率和异位妊娠率。
结果
序贯 ET 组的着床率（32.1%）、血 hCG 阳性率（58.9%）和临床妊娠率（50.7%）显著高于 3 天卵裂期 ET 组（24.9%、46.5%、40.4%），与囊胚移植组（30.1%、56.4%、47.1%）相似。囊胚移植组的早期流产率（17.2%）显著高于卵裂期 ET 组（8.1%）（0.05），而异位妊娠率（0.4%）显著低于卵裂期 ET 组（3.0%）（0.05）。序贯 ET 组的多胎妊娠率（17.0%）显著低于卵裂期 ET 组（25.5%）（0.05）和囊胚移植组（27.6%）（0.05）。当排除囊胚培养失败的周期后，序贯 ET 组的临床妊娠率（55.7%）显著高于双囊胚 ET 组（47.1%）（0.05），早期流产率（8.5%）和多胎妊娠率（17.7%）显著低于双囊胚 ET 组（17.2%）和（27.6%）（0.05）。
结论
FET 周期中的序贯胚胎移植可以提高 RIF 患者的临床结局。
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