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目的 分析高龄卵巢储备功能减退(DOR)患者行冻融胚胎移植(FET)时卵裂期胚胎与囊胚的妊娠结局及活产率相关影响因素。方法 回顾性分析2017年6月至2024年6月在河池市人民医院生殖医学中心行FET且年龄≥35岁的DOR患者临床资料，共522个周期。按照患者移植胚胎类型分为两组：D3组(移植冷冻卵裂期胚胎，n=420)和BT组(移植冷冻囊胚，n=102),再根据患者年龄分为：35～37岁组(n=65)、38～40岁组(n=145)、41～42岁组(n=122)、43～44岁组(n=114)及>44岁组(n=76)。比较整体及不同年龄亚组下D3与BT两组间患者的妊娠结局及相关指标，进一步采用多因素Logistic回归分析影响高龄DOR患者活产率的相关因素。结果 整体两组比较显示，D3组的临床妊娠率、流产率及活产率均显著低于BT组(P<0.05)。不同年龄组的妊娠结局结果显示，各年龄段临床妊娠率和活产率均随年龄增加而降低，流产率则随年龄增加而上升，且与>44岁组相比，35～37岁组、38～40岁组及41～42岁组均有显著差异(P<0.05)。同年龄段下D3与BT组的妊娠结局比较，除35～37岁年龄段外，与D3组相比，各年龄段BT组在移植胚胎及移植优胚数显著减少的情况下，均有着较高的临床妊娠率和活产率以及较低的双胎率。多因素Logistic回归分析结果显示，年龄是高龄DOR患者获得活产的危险因素[OR=0.74,95%CI(0.67,0.81),P<0.001]。结论 高龄DOR不孕患者移植冻融囊胚比移植卵裂胚能够获得更好的临床结局，且活产率随年龄增长而下降。年龄是高龄DOR患者获得活产的独立影响因素。
Abstract：Objectives:To analyze pregnancy outcomes and related influencing factors of cleavage stage embryos and blastocysts in elderly patients with ovarian reserve dysfunction(DOR) undergoing frozen-thawed embryo transfer(FET).Methods:A retrospective analysis of clinical data of patients aged not less than 35 years old and with ovarian reserve dysfunction who underwent FET with 522 cycles in total performed at the Reproductive Medicine Center of Hechi People's Hospital from June 2017 to June 2024.According to the stage of embryo transfer, patients were divided into two groups: D3 group(transferring frozen cleavage embryos, n=420) and BT group(transferring frozen blastocysts, n=102),and further divided into five subgroups as 35-37-year-old group(n=65),38-40-year-old group(n=145),41-42-year-old group(n=122),43-44-year-old group(n=114),and over 44-year-old group(n=76) based on their ages. The pregnancy outcomes and related indicators of D3 and BT patients in the overall and different age subgroups. The multiple logistic regression was used to further analyze the factors related to live birth rates in elderly patients.Results:The pregnancy rate, the miscarriage rate, and the live birth rate in the D3 group were significantly lower than those of the BT group(P<0.05). The pregnancy outcomes across different age groups revealed that both the clinical pregnancy rate and the live birth rate declined with increasing age, whereas the miscarriage rate rose accordingly. Notably, when compared with the group aged over 44,significant differences were observed in the groups aged 35-37,38-40,and 41-42(P<0.05). The pregnancy outcomes of D3 and BT groups in the same age group showed that, except for the 35-37-year-old group, the BT group had higher clinical pregnancy rates and live birth rates as well as lower twin rates in all age groups, with a significant reduction in the number of transplanted embryos and high-quality embryos. The results of the multifactorial logistic regression analysis indicated that the age was an impact factor for live birth in elderly patients with DOR [OR=0.74,95%CI(0.67,0.81),P<0.001].Conclusions:In elderly DOR infertile patients, the transfer of frozen-thawed blastocysts results in better clinical outcomes than the transfer of cleavage-embryo. And the live birth rate decreases with age. Age is an independent influencing factor for live birth in elderly DOR patients.
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基本信息:
中图分类号:R714.8
引用信息:
[1]屈春凤,邓颖芸,莫凤明,等.高龄卵巢储备功能减退患者冻融胚胎移植妊娠结局分析[J].生殖医学杂志,2026,35(03):290-296.
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