影响体外受精新鲜胚胎移植成功结局的决定因素：一项回顾性队列研究
Determining Factors Affecting the Successful Outcome of Fresh Embryo Transfer During In Vitro Fertilization: A Retrospective Cohort Study.
作者信息
Suebthawinkul Chanakarn, Numchaisrika Pranee, Chaengsawang Akarawin, Pilaisangsuree Vijakhana, Summat Sadanan, Peawdang Araya, Patchima Konkanok, Tuntiviriyapun Punkavee, Thuwanut Paweena, Sirayapiwat Porntip, Sereepapong Wisan
机构信息
Department of Obstetrics and Gynecology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
King Chulalongkorn Memorial Hospital (KCMH), The Thai Red Cross Society, Bangkok, Thailand.
出版信息
J Reprod Infertil. 2024 Oct-Dec;25(4):253-263. doi: 10.18502/jri.v25i4.18123.
BACKGROUND
Fresh embryo transfer has been decreasing because of advancements in vitrification techniques and safety concerns related to ovarian hyperresponse. However, in normal responders, clinical outcomes appear to be comparable with those with frozen embryo transfer. This study aimed to determine factors that influence successful fresh embryo transfer.
METHODS
This retrospective cohort study included 521 women who underwent in vitro fertilization (IVF) and fresh embryo transfer at King Chulalongkorn Memorial Hospital, Thailand. Patients' clinical data, embryo details, endometrial characteristics (thickness and pattern), and embryo transfer procedures (tip and flow during transfer, embryo placement location, difficulty of the procedure, and presence of blood and mucous at catheter) were analyzed. Chi-square test, Fisher's exact test, Student's t-test, and logistic regression were performed for data analysis. A p-value of <0.05 was considered statistically significant.
RESULTS
The overall clinical pregnancy rate was 17.1%. Women aged >40 years were less likely to have a clinical pregnancy than those aged <35 years (adjusted odds ratio [aOR] 0.422; 95% confidence intervals [CI] 0.196-0.908, p=0.027). Day 3 embryo transfer showed a significant decrease in clinical pregnancy compared with blastocyst transfer (aOR 0.514; 95%CI 0.287-0.923, p=0.026). In the subgroup analysis for blastocyst transfer, women with good-quality blastocyst (≥322) were 2.439 times more likely to have a clinical pregnancy than those with poor-quality blastocysts (aOR 2.439; 95%CI 1.199-4.962, p=0.014).
CONCLUSION
Advanced age and day 3 embryo transfer were significantly associated with low clinical pregnancy rates in fresh embryo transfer.
背景
由于玻璃化技术的进步以及与卵巢过度刺激相关的安全问题，新鲜胚胎移植的比例一直在下降。然而，对于正常反应者，其临床结局似乎与冷冻胚胎移植相当。本研究旨在确定影响新鲜胚胎移植成功的因素。
方法
这项回顾性队列研究纳入了521名在泰国朱拉隆功国王纪念医院接受体外受精（IVF）和新鲜胚胎移植的女性。分析了患者的临床数据、胚胎细节、子宫内膜特征（厚度和形态）以及胚胎移植过程（移植过程中的尖端和流速、胚胎放置位置、操作难度以及导管处有无血液和黏液）。采用卡方检验、Fisher精确检验、学生t检验和逻辑回归进行数据分析。p值<0.05被认为具有统计学意义。
结果
总体临床妊娠率为17.1%。年龄>40岁的女性临床妊娠的可能性低于年龄<35岁的女性（调整后的优势比[aOR]为0.422；95%置信区间[CI]为0.196 - 0.908，p = 0.027）。与囊胚移植相比，第3天胚胎移植的临床妊娠率显著降低（aOR为0.514；95%CI为0.287 - 0.923，p = 0.026）。在囊胚移植的亚组分析中，优质囊胚（≥322）的女性临床妊娠的可能性是劣质囊胚女性的2.439倍（aOR为2.439；95%CI为1.199 - 4.962，p = 0.014）。
结论
高龄和第3天胚胎移植与新鲜胚胎移植的低临床妊娠率显著相关。
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