首次冻融胚胎移植周期中移植单囊胚与双卵裂胚的临床结局比较OA

Objectives:To investigate the effects of transferring one blastocyst and two cleavage stage embryos during freeze-thaw embryo cycle on pregnancy outcomes,and to provide more references for the selection of different types of embryos in clinical practice. Methods:The clinical data of 3 379 cycles of patients aged 20 to less than 40 years who underwent frozen embryo transfer(FET)in the Department of Reproductive Medicine,Women and Children's Hospital of Xiamen University from January 2016 to May 2024 were retrospectively analyzed,and the patients were divided into appropriate age group(20 to less than 35 years,n=2 801)and advanced age group(35 to less than 40 years,n=578)according to their age.Patients in each group were further divided into three subgroups according to different types of embryos transferred:double cleavage embryos group(two cleavage embryos transferred on the third day after fertilization,including one high-quality cleavage embryo and one non-high-quality cleavage embryo),single excellent blastocyst group(one high-quality blastocyst transferred)and single non-excellent blastocyst group(one non-high-quality blastocyst transferred). Results:There were no significant differences in the clinical pregnancy rate,live birth rate and early abortion rate between the single blastocyst group and the double cleavage group(P＞0.05).The multiple pregnancy rate(1.9％vs.35.0％)and ectopic pregnancy rate(0.9％vs.2.5％)in the single excellent blastocyst group were significantly lower than those in the double cleavage group(P＜0.05),and the male birth rate(61.4％vs.52.0％)in the single excellent blastocyst group was significantly higher than that in the double cleavage group(P=0.021).There were no significant differences in the rates of premature delivery,birth deformity,low birth weight and macrosomia between the two groups(P＞0.05).The clinical pregnancy rate(53.5％vs.68.2％),live birth rate(42.7％vs.59.7％),multiple pregnancy rate(2.4％vs.35.0％)and ectopic pregnancy rate(0.5％vs.2.5％)in the single non-excellent blastocyst group were significantly lower than those of the double cleavage group(P＜0.05).There were no significant differences in the rates of premature birth,male birth,birth deformity,low birth weight and macrosomia between the double cleavage group and the single non-excellent blastocyst group(P＞0.05).As for advanced age group,there were no significant differences in the clinical pregnancy rate,live birth rate,early abortion rate and ectopic pregnancy rate between the double cleavage group and single excellent blastocyst group(P＞0.05),but the multiple pregnancy rate in the single excellent blastocyst group(3.9％vs.21.1％)was significantly lower than that of the double cleavage group(P＜0.001).The clinical pregnancy rate(42.2％vs.60.3％),live birth rate(33.3％vs.48.4％)and the multiple pregnancy rate(2.3％vs.21.1％)in the single non-excellent blastocyst group were significantly lower than those of the double cleavage group(P all＜0.001).There were no significant differences in the rates of premature birth,male birth,birth deformity,low birth weight and macrosomia among the single excellent blastocyst group,the single non-excellent blastocyst group and the double cleavage group(P＞0.05). Conclusions:In the first FET cycle,single high-quality blastocyst transfer is preferred.When there is no high-quality blastocyst,one high-quality cleavage embryo and one non-high-quality cleavage embryo can be transferred if the patient has no contraindication for twin pregnancy.