生殖医学杂志

目的 探讨囊胚质量对冻融单囊胚移植患者临床妊娠及新生儿结局的潜在影响。方法 回顾性分析2015年1月至2024年11月于我中心行冻融单囊胚移植的15 660个周期的临床资料，根据囊胚质量分为3组：优质囊胚组(A组，9 681个周期),中等质量囊胚组(B组，4 395个周期),低质量囊胚组(C组，1 584个周期)。比较3组患者间的一般资料、妊娠结局、新生儿结局，应用多因素Logistic回归分析囊胚质量与妊娠结局的关系。结果 3组患者间年龄[冻融胚胎移植(FET)时年龄和取卵时年龄]、女方体质量指数(BMI)、不孕年限、不孕类型、不孕因素、受精方式、双原核(2PN)数、内膜准备方案、FET周期数、不同时期囊胚比例比较均有显著性差异(P<0.05)。3组患者的临床妊娠率(68.3%vs. 56.5%vs. 42.6%)、活产率(57.2%vs. 44.5%vs. 33.3%)两两比较均有显著性差异(P<0.05);B、C组的早期流产率显著高于A组(17.4%、17.8%vs. 12.7%,P<0.05)。3组患者间早产儿、低体重儿和巨大儿出生率比较均无显著性差异(P>0.05),但与其他两组比较，A组有更高的男性胎儿出生率(57.6%vs. 51.1%、52.5%,P<0.05)。逻辑回归模型调整了女方移植年龄、取卵年龄、女方BMI、移植周期数、内膜准备方案后，与A组相比，另两组患者的临床妊娠率和活产率均显著降低(P<0.001)。结论 囊胚质量显著影响患者的临床妊娠率、活产率，但对新生儿出生体重和早产率没有明显影响。

Objectives:To investigate the potential impact of blastocyst quality on clinical pregnancy and neonatal outcome in patients undergoing freeze-thawed embryo transfer(FET) with single blastocyst.Methods:The clinical data of 15 660 FET cycles with single blastocyst at The ART Center of Northwest Women's and Children's Hospital from January 2015 to November 2024 were retrospectively analyzed. The patients were divided into three groups according to the quality of blastocysts: high-quality blastocysts group(group A,9 681 cycles),intermediate-quality blastocysts group(group B,4 395 cycles),and low-quality blastocysts group(group C,1 584 cycles). General characteristics, pregnancy outcomes, and neonatal outcomes were compared among the three groups. A multivariate logistic regression analysis was then applied to evaluate the relationship between blastocyst quality and pregnancy outcomes.Results:There were significant differences in age(age at FET and oocyte retrieval),female body mass index(BMI),infertility duration, the infertility type, the infertility cause, the fertilization method, number of two pronuclei(2PN),endometrial preparation protocol, number of FET cycles, proportion of blastocysts at different stages among the three groups(P<0.05). There were significant differences in the clinical pregnancy rate(68.3% vs. 56.5% vs. 42.6%) and live birth rate(57.2% vs. 44.5% vs. 33.3%) among the three groups compared pairwise(P<0.05). The early miscarriage rates of group B and C were significantly higher than that of group A(17.4%、17.8% vs. 12.7%,P<0.05). There were no significant differences in the percentage of preterm birth, low-birth-weight newborn and macrosomia among the three groups(P>0.05),but there was a higher rate of male fetus births in group A when compared with the other two groups(P<0.05). The logistic regression model adjusted for female age at FET and oocyte retrieval, female BMI,number of FET cycles, endometrial preparation protocol and then lower clinical pregnancy and live birth rates were found in the other two groups when compared with group A(P<0.001).Conclusions:Blastocysts quality significantly affects the clinical pregnancy rate, and the rate of live births, but it has no significant effect on the birth weight and premature birth rate of newborns.