大于38岁女性冻融移植周期单囊胚与双囊胚移植妊娠结局比较OACSTPCD

Objective:To explore the pregnancy outcomes with different numbers and qualities of blastocyst for frozen-thawed embryo transfer cycles among women over 38 years old. Methods:A retrospective analysis of 249 women aged over 38 years who underwent frozen-thawed blastocyst transfer at the Reproductive Medicine Centre of Guangdong Provincial Reproductive Fertility Hospital from January 2017 to December 2021 was performed,and the patients were classified according to the number and quality of transferred blastocysts into 5 groups:single high-quality blastocyst group(group A,94 cycles),single not-high-quality blastocyst group(group B,103 cycles),double high-quality blastocyst group(group C,10 cycles),single high-quality blastocyst+single not-high-quality blastocyst group(group D,18 cycles),and double not-high-quality blastocyst group(group E,24 cycles).A comparative analysis of basic characteristics,embryo laboratory parameters and pregnancy outcomes was conducted among different groups. Results:When comparison of the basic characteristics among difference groups,the age at retrieval in group D was older than that of group A(P＜0.05),and the basal follicle-stimulating hormone(FSH)levels in group C and group E were lower than those of group A and group B,respectively(P＜0.05).There were no significant differences in the age at transfer,the number of antral follicles,body mass index(BMI),gonadotropin(Gn)dosage,the endothelial thickness on the transfer day,and the percentages of artificial cycle among the different groups(P＞0.05).The number of oocytes in group E was higher than that of group B[(12.67±4.98)vs.(10.69±4.08),P＜0.05].There were no significant differences in the numbers of day 3 embryos,high quality embryos,blastocysts cultured,blastocysts formed and frozen blastocysts among different groups(P＞0.05).When compared group A with group C,there were no differences in the implantation rate,clinical pregnancy rate,spontaneous abortion rate,live birth rate as well as premature birth rate,while multiple pregnancy rate in group A was markedly lower than that in group C(6.00％vs.33.30％,P＜0.05).Compared to group D,group A had a similar live birth rate(35.10％vs.33.30％,P＞0.05)and a higher rate of implantation(53.20％vs.27.80％,P＜0.05).When compared group A with group E,there were no significant differences in the implantation rate,clinical pregnancy rate,spontaneous abortion rate,premature birth rate and live birth rate,but a lower multiple pregnancy rate ingroup A(6.00％vs.33.30％,P＜0.05).The clinical pregnancy rate and multiple pregnancy rate of group B were significant lower than group E(P＜0.05),but there were no significant differences in the implantation rate,spontaneous abortion rate,live birth rate and premature birth rate between the two groups(P＞0.05). Conclusions:Women over 38 years old are recommended to preferentially transfer a single high-quality blastocyst in frozen-thawed blastocyst transfer cycles if high-quality blastocysts are available.If high-quality blastocysts are not available,transfer of a single blastocyst should also be considered.