Comparison of live birth rate between frozen-thawed single and double cleavage-stage embryo transfer and single blastocyst transfer in advanced age females and related influencing factors

doi:10.16150/j.1671-2870.2020.01.011

Abstract

Abstract:

Objective: To analyze the pregnancy outcome and influencing factors related to live birth rate of single cleavage-stage embryos, double cleavage-stage embryos and single blastocyst transfer in elderly patients (40≤age≤50 years) who underwent frozen-thawed embryo transfer. Methods: The elderly patients undergone frozen-thawed embryo transfer from January 2010 to June 2018 were enrolled. The patients were divided into three groups according to the number and stage of transferred embryo: Group D3(Day3, embryo transferred was the third day after fertilization, n=1 363), Group 2D3(two embryos transferred were the third day after fertilization, n=5 248) and Group BT (blastocyst transferred was the fifth or sixth day after fertilization, n=495). Live birth outcome was analyzed and related influencing factors were explored by multivariate Logistic regression. Results: There were significant differences in live birth rates (6.53% vs. 13.38% vs. 18.38%) between the three groups（D3, 2D3, BT）(P<0.01). Twin live birth rate was the highest in 2D3 group (1.12% vs. 7.98% vs. 1.10%)(P<0.05). Multivariate logistic regression analysis revealed that when 2D3 was taken as the reference group, the live birth rate of D3 group was lower (OR=0.558, 95%CI 0.440-0.707, P<0.001), and the live birth rate of BT group had a trend of rising (OR=1.257, 95%CI 0.977-1.617, P=0.075). The live birth rate was negatively correlated with the increase of age（OR=0.685, 95%CI=0.654-0.718） and BMI (OR=0.961, 95%CI=0.935-0.987), and the use of endometrium preparation method (hormone replacement method, with ovulation cycle as reference) might lead to a lower live birth rate(OR=0.736, 95%CI=0.631-0.857). And the live birth rate was positively correlated with thicker endometrium (OR=1.058, 95%CI=1.024-1.094). The live birth rates of patients at 40, 41, 42, 43, 44 and 45 years old were calculated. It was found that the live birth rate was higher in BT group of different ages (P=0.024, 0.01, 0.198, 0.009, 0.102, 0.064), and the live birth rate gradually decreased with the increase of age. Conclusions: Single blastocyst transfer in elderly patients can achieve a similar live birth rate compared to double cleavage-stage embryo transfer, but twin delivery is lower.

Key words: Advanced maternal age, Infertility, In vitro fertilization and embryo transfer, Frozen-thawed embryo transfer

CLC Number:

R713

CONG Yanyan, SHEN Xi, KUANG Yanping. Comparison of live birth rate between frozen-thawed single and double cleavage-stage embryo transfer and single blastocyst transfer in advanced age females and related influencing factors[J]. Journal of Diagnostics Concepts & Practice, 2020, 19(1): 50-54.

Figures/Tables 5

References 11

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参数	BT组	D3组	2D3组	P值
病例数（n）	495	1 363	5 248
年龄（岁）	41.92±1.89^a),b)	43.23±2.49^b),c)	42.54±2.26^a),c)	<0.001
不孕年限（年）	4.82±4.56	5.12±5.13	5.13±4.90	0.408
BMI（kg/m²）	22.36±2.95	22.56±2.70	22.50±2.86	0.404
不孕类型(%)				0.643
原发不孕	131（26.46）^a)	335（24.58）^b),c)	1 344（25.61）^a)
继发不孕	364（73.54）^a)	1 028（75.42）^b),c)	3 904（74.39）^a)
不孕原因(%)				<0.001
女性因素	331（66.87）^b)	895（65.66）^b)	3 129（59.62）^a),c)
男性因素	36（7.27）	92（6.75）b)	533（10.16）^a)
混合因素	79（15.96）	219（16.07）	764（14.56）
不明原因	49（9.90）^b)	157（11.52）^b)	822（15.66）^a),c)
授精方式(%)				<0.001
IVF	333（67.27）	874（64.12）	3 284（62.58）
ICSI	162（32.73）	489（35.88）	1 852（35.29）
IVF-ICSI	0（0.00）^b)	0（0.00）^b)	112（2.13）^a),c)

参数	BT组	D3组	2D3组	P值
内膜准备方案（%）
促排卵周期	309（62.42）^a),b)	644（47.25）^b),c)	2 832（53.96）^a),c)	<0.001
激素替代	186（37.58）^a),b)	719（52.75）^b),c)	2 416（46.04）^a),c)	<0.001
内膜厚度(mm)	9.90±2.09	9.81±2.17^a)	10.01±2.17	0.010
生化妊娠率（%）	172（34.75）^a),b)	197（14.45）^b),c)	1 434（27.32）^a),c)	<0.001
临床妊娠率（%）	153（30.91）^a),b)	159（11.67）^b),c)	1 208（23.02）^a),c)	<0.001
活产率（%）	91（18.38）^a),b)	89（6.53）^b),c)	702（13.38）^a),c)	<0.001
双胎活产率（%）	1/91（1.10）^b)	1/89（1.12）^b)	56/702（7.98）^a),c)	0.002
早产率（%）	7/91（7.69）	6/89（6.74）	68/702（9.69）	0.579
低体重出生儿（%）	6/92（6.52）	8/90（8.89）	81/758（10.69）	0.421
出生缺陷（%）	0/92（0.00）	0/90（0.00）	7/758（0.92）	>0.999

因素	OR（95%CI）	P值
患者年龄	0.671（0.641~0.702）	<0.001
不孕年限	0.991（0.976~1.005）	0.213
BMI	0.946（0.921~0.972）	<0.001
内膜厚度	1.074（1.040~1.108）	<0.001
不孕原因		0.474
女性因素	1.000
男性因素	1.169（0.922~1.482）	0.197
混合因素	0.935（0.759~1.152）	0.530
不明原因	1.043（0.850~1.279）	0.688
授精方式		0.213
IVF	1.000
ICSI	0.928（0.799~1.078）	0.330
IVF+ICSI	1.414（0.857~2.334）	0.176
内膜准备方案
促排卵方案	1.000
激素替代	0.629（0.544~0.727）	<0.001
孕次分组
原发不孕	1.000
继发不孕	0.798（0.683~0.933）	0.005
分组
2D3	1.000
D3	0.452（0.360~0.569）	<0.001
BT	1.459（1.146~1.856）	0.002

因素	OR（95%CI）	P值
患者年龄	0.685（0.654~0.718）	<0.001
BMI	0.961（0.935~0.987）	0.004
内膜厚度	1.058（1.024~1.094）	<0.001
内膜准备方案
促排卵方案	1.000
激素替代	0.736（0.631~0.857）	<0.001
孕次分组
原发不孕	1.000
继发不孕	1.028（0.873~1.212）	0.739
分组
2D3	1.000
D3	0.558（0.440~0.707）	<0.001
BT	1.257（0.977~1.617）	0.075