拮抗剂方案鲜胚移植胚胎数与质量对辅助生殖技术妊娠结局影响的探究

王洋洋; 张丹丹; 汤美玲; 沈澍

doi:10.13898/j.cnki.issn.2097-5252.2025.03.019

拮抗剂方案鲜胚移植胚胎数与质量对辅助生殖技术妊娠结局影响的探究

Effect of the number and quality of embryos transferred from fresh embryo with antagonist regimen on pregnancy outcome of assisted reproductive technology

摘要

摘要:
目的探究辅助生殖技术助孕过程中，拮抗剂方案鲜胚移植胚胎数与质量对妊娠结局的影响。
方法回顾性分析308个鲜胚移植周期拮抗剂方案病人的相关资料。根据移植胚胎数及优质胚胎数分成3组，A组(移植1枚优质胚胎)、B1组(移植1枚优质胚胎+1枚非优质胚胎)和B2组(移植2枚优质胚胎)。比较各组病人一般资料、促排卵情况及实验室数据和妊娠结局的差异。
结果 A组不孕年限低于B2组(P < 0.05)。A组可移植胚胎数、优质胚胎数及冷冻胚胎数高于B1组，可移植胚胎数和优质胚胎数低于B2组，B1组获卵数、成熟卵母细胞数、双原核胚胎数、可移植胚胎数、优质胚胎数及冷冻胚胎数低于B2组(P < 0.05~P < 0.01)。3组人绒毛膜促性腺激素阳性率、临床妊娠率、种植率、活产率差异有统计学意义(P < 0.01)，B2组上述指标均高于A、B1组(P < 0.05)。卵巢过度刺激综合征及多胎妊娠均在B2组发生。logistic回归分析显示，窦卵泡数、优质胚胎数及移植2枚优质胚胎是临床妊娠的保护因素(P < 0.05~P < 0.01)。
结论对于鲜胚移植周期使用拮抗剂方案病人，在移植1枚优质胚胎的基础上增加移植1枚非优质胚胎不能提高临床妊娠率，增加移植1枚优质胚胎虽然可以提高临床妊娠率，但多胎妊娠率也会显著增加；拮抗剂方案卵巢过度刺激综合征发生率较低。

Abstract:
Objective To explore the effects of the number and quality of embryos transferred from fresh embryo with antagonist regimen on pregnancy outcome of assisted reproductive technology.
Methods The data of 308 patients with fresh embryo transfer cycle antagonist regimen were retrospectively analyzed.According to the number of embryos transferred and number of high-quality embryos, they were divided into 3 groupsgroup A(transfer of 1 high-quality embryo), group B1(transfer of 1 high-quality embryo +1 non-high-quality embryo), and group B2(transfer of 2 high-quality embryos).The differences of general information, ovulation induction, laboratory data and pregnancy outcome were compared among all groups.
Results The infertility years in group A was lower than that in group B2(P < 0.05).The number of transferable embryos, high-quality embryos and frozen embryos in group A were higher than that in group B1, the number of transferable embryos and high-quality embryos in group A were lower than that in group B2, and the number of eggs obtained, number of oocyte with metaphase Ⅱ(MⅡ), number of embryos with two pronuclear(2PN), transferable embryos, high-quality embryos and frozen embryos in group B1 were lower than those in group B2(P < 0.05 to P < 0.01).The differences of positive rate of human chorionic gonadotropin(β-hCG), clinical pregnancy rate, implantation rate and live birth rate were statistically significant among three groups(P < 0.01), and the above indexes in group B2 were higher than those in groups A and B1(P < 0.05).The ovarian hyperstimulation syndrome(OHSS) and multiple pregnancies occurred in group B2.The results of logistic regression analysis showed that the number of antral follicle number(AFC), number of high-quality embryos and transfer of two high-quality embryos were the protective factors of clinical pregnancy(P < 0.05-P < 0.01).
Conclusions For patients using GnRH antagonist protocol during fresh embryo transfer cycle, transfer one high-quality embryo and one non-high-quality embryo can not improve the clinical pregnancy rate.Although adding one high-quality embryo to transfer can improve the clinical pregnancy rate, the multiple pregnancy rate will also increase significantly.The incidence of OHSS in GnRH antagonist protocol is lower.

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