Department of Obstetrics and Gynecology, Peking University First Hospital, Beijing, 100034, P. R. China.
Reprod Biol Endocrinol. 2024 Feb 21;22(1):26. doi: 10.1186/s12958-024-01194-x.
To evaluate the impact of embryo quality and quantity, specifically a poor quality embryo (PQE) in combination with a good quality embryo (GQE), by double embryo transfer (DET) on the live birth rate (LBR) and neonatal outcomes in patients undergoing frozen-thawed embryo transfer (FET) cycles.
A study on a cohort of women who underwent a total of 1462 frozen-thawed cleavage or blastocyst embryo transfer cycles with autologous oocytes was conducted between January 2018 and December 2021. To compare the outcomes between single embryo transfer (SET) with a GQE and DET with a GQE and a PQE, propensity score matching (PSM) was applied to control for potential confounders, and a generalized estimating equation (GEE) model was used to determine the association between the effect of an additional PQE and the outcomes. Subgroup analysis was also performed for patients stratified by female age.
After PS matching, DET-GQE + PQE did not significantly alter the LBR (adjusted odds ratio [OR] 1.421, 95% CI 0.907-2.228) compared with SET-GQE in cleavage-stage embryo transfer but did increase the multiple birth rate (MBR, [OR] 3.917, 95% CI 1.189-12.911). However, in patients who underwent blastocyst-stage embryo transfer, adding a second PQE increased the live birth rate by 7.8% ([OR] 1.477, 95% CI 1.046-2.086) and the multiple birth rate by 19.6% ([OR] 28.355, 95% CI 3.926-204.790), and resulted in adverse neonatal outcomes. For patients who underwent cleavage-stage embryo transfer, transferring a PQE with a GQE led to a significant increase in the MBR ([OR] 4.724, 95% CI 1.121-19.913) in women under 35 years old but not in the LBR ([OR] 1.227, 95% CI 0.719-2.092). The increases in LBR and MBR for DET-GQE + PQE compared with SET-GQE in women older than 35 years were nonsignificant toward. For patients who underwent blastocyst-stage embryo transfer, DET-GQE + PQE had a greater LBR ([OR] 1.803, 95% CI 1.165-2.789), MBR ([OR] 24.185, 95% CI 3.285-178.062) and preterm birth rate (PBR, [OR] 4.092, 95% CI 1.153-14.518) than did SET-GQE in women under 35 years old, while no significant impact on the LBR ([OR] 1.053, 95% CI 0.589-1.884) or MBR (0% vs. 8.3%) was observed in women older than 35 years.
The addition of a PQE has no significant benefit on the LBR but significantly increases the MBR in patients who underwent frozen-thawed cleavage-stage embryo transfer. However, for patients who underwent blastocyst-stage embryo transfer, DET-GQE + PQE resulted in an increase in both the LBR and MBR, which may lead to adverse neonatal outcomes. Thus, the benefits and risks of double blastocyst-stage embryo transfer should be balanced. In patients younger than 35 years, SET-GQE achieved satisfactory LBR either in cleavage-stage embryo transfer or blastocyst-stage embryo transfer, while DET-GQE + PQE resulted in a dramatically increased MBR. Considering the low LBR in women older than 35 years who underwent single cleavage-stage embryo transfer, selective single blastocyst-stage embryo transfer appears to be a more promising approach for reducing the risk of multiple live births and adverse neonatal outcomes.
本研究旨在评估胚胎质量和数量的影响，特别是通过双胚胎移植（DET）将一个质量差的胚胎（PQE）与一个质量好的胚胎（GQE）结合使用，对接受冻融胚胎移植（FET）周期的患者的活产率（LBR）和新生儿结局的影响。
对 2018 年 1 月至 2021 年 12 月期间接受了总共 1462 个自体卵子冻融卵裂期或囊胚胚胎移植周期的女性患者进行了一项研究。为了比较单胚胎移植（SET）与 GQE 和 DET 与 GQE 和 PQE 的结果，应用倾向评分匹配（PSM）来控制潜在的混杂因素，并使用广义估计方程（GEE）模型来确定额外 PQE 的效果与结果之间的关联。还对按女性年龄分层的患者进行了亚组分析。
在 PS 匹配后，与 SET-GQE 相比，DET-GQE+PQE 并未显著改变卵裂期胚胎移植的 LBR（调整后的优势比 [OR] 1.421，95%CI 0.907-2.228），但增加了多胎妊娠率（MBR，[OR] 3.917，95%CI 1.189-12.911）。然而，在接受囊胚期胚胎移植的患者中，添加第二个 PQE 可使活产率提高 7.8%（[OR] 1.477，95%CI 1.046-2.086）和多胎妊娠率提高 19.6%（[OR] 28.355，95%CI 3.926-204.790），并导致不良新生儿结局。对于接受卵裂期胚胎移植的患者，携带 GQE 的 PQE 会导致 35 岁以下女性的 MBR 显著增加（[OR] 4.724，95%CI 1.121-19.913），但 LBR 无显著增加（[OR] 1.227，95%CI 0.719-2.092）。对于年龄大于 35 岁的患者，与 SET-GQE 相比，DET-GQE+PQE 并未显著增加 LBR 和 MBR。对于接受囊胚期胚胎移植的患者，DET-GQE+PQE 与 SET-GQE 相比，LBR（[OR] 1.803，95%CI 1.165-2.789）、MBR（[OR] 24.185，95%CI 3.285-178.062）和早产率（PBR，[OR] 4.092，95%CI 1.153-14.518）更高，而 LBR（[OR] 1.053，95%CI 0.589-1.884）和 MBR（0%比 8.3%）无显著变化。
在接受冻融卵裂期胚胎移植的患者中，添加 PQE 对 LBR 无显著益处，但显著增加了 MBR。然而，对于接受囊胚期胚胎移植的患者，DET-GQE+PQE 导致 LBR 和 MBR 均增加，这可能导致不良新生儿结局。因此，应该权衡双囊胚期胚胎移植的益处和风险。对于年龄小于 35 岁的患者，SET-GQE 无论是在卵裂期胚胎移植还是囊胚期胚胎移植中，均能获得满意的 LBR，而 DET-GQE+PQE 则导致 MBR 显著增加。考虑到年龄大于 35 岁的患者单卵裂期胚胎移植的 LBR 较低，选择性单囊胚期胚胎移植似乎是降低多胎活产和不良新生儿结局风险的更有前途的方法。
