Should we transfer poor quality embryos?
Should we transfer poor quality embryos?
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DOI：
10.1186/s40738-020-00072-5
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发表时间：
2020-01-01
影响因子：
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通讯作者：
Sukhikh, Gennady
中科院分区：
文献类型：
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作者：
Kirillova, Anastasia;Lysenkov, Sergey;Sukhikh, Gennady
背景：评价移植劣质胚胎是否安全有效。方法：采用阳性对照的病例资料进行回顾性分析。在2012至2016年间进行的新鲜体外受精(IVF)周期中，所有在第3天或第5天接受低质量胚胎移植的患者。这项研究评估了488个试管受精项目中的738个质量不佳的胚胎。在第3天进行胚胎移植261枚(402枚)，在第5天进行227枚(336枚)。对照组为5994个体外受精项目中的9893个优质胚胎。采用R软件中的FISTER检验函数，与双尾Fisher精确检验进行比较。按年龄、体重指数(BMI)、卵母细胞数、男女主要诊断、周期类型、控制卵巢刺激(COS)方案、促性腺激素开始用药日、促性腺激素起始量、促性腺激素总剂量、促性腺激素用药总天数、促性腺激素释放激素(GnRH)激动剂开始用药天数、促性腺激素释放激素激动剂(GnRH)激动剂用药总天数、促性腺激素释放激素激动剂(GnRH)激动剂的总用药量结果：不良胚胎组第3天和第5天的植入率、临床妊娠率、流产率、活产数、新生儿数均无显著差异。虽然不良胚胎组的种植率低于对照组(13.9%比37.2%)，但差异无统计学意义。两组移植胚胎的临床妊娠率和活产率差异无统计学意义(分别为72%和78.2%，55.8%和62.0%)。结论：无论是在第3天还是第5天，移植质量较差的胚胎的植入潜力都很低，但成功移植的胚胎与质量良好的胚胎具有相同的活产潜力。这项研究支持，当劣质胚胎是新鲜胚胎移植(ET)的唯一选择时，移植它们是安全的。
BACKGROUND: To evaluate if it is safe and effective to transfer poor quality embryos.METHODS: It was a retrospective analysis using individual patient data with positive controls. All patients undergoing embryo transfers of poor quality embryos on day 3 or on day 5 as part of fresh In Vitro Fertilization (IVF) cycles performed between 2012 and 2016. This study assessed a total of 738 poor quality embryos from 488 IVF programs. 261 embryo transfers were performed on day 3 (402 embryos were transferred) and 227 on day 5 (336 embryos were transferred). Control group consisted of 9893 fair and good quality embryos from 5994 IVF programs. Outcome rates were compared with two-tailed Fisher exact test using fisher.test function in R software. 95% confidence intervals for proportions were calculated using the Clopper-Pearson method with binom.test function in R. The groups of patients with poor vs. good and fair quality embryos were compared by age, body mass index(BMI), number of oocytes, female and male main diagnosis, cycle type, controlled ovarian stimulation (COS) protocol, the starting day of gonadotropin administration, the starting dose of gonadotropins, the total dose of gonadotropins, the total number of days of gonadotropins administration, the starting day of gonadotropin-releasing hormone (GnRH) agonist administration, the total number of ampoules of GnRH-agonist used, day of the trigger of ovulation administration and the type of the trigger of ovulation using the Student's t-test for interval variables and with the chi-square test for nominal variables.RESULTS: No significant differences in the implantation rate, clinical pregnancy rate, miscarriage rate, live births, and the number of children born were found between the groups of poor quality embryos transferred on day 3 and day 5. Though the implantation rate was lower for the group of poor quality embryos, than for the control (13.9% vs 37.2%), statistically significant differences between the proportion of implanted embryos which resulted in clinical pregnancies and live births in both groups were not observed (72% vs 78.2 and 55.8% vs 62.0% respectively).CONCLUSION: Transfer of poor quality embryos at either day 3 or day 5 have a low potential for implantation, though those embryos which successfully implanted have the same potential for live birth as the embryos of fair and good quality. This study supports that it is safe to transfer poor quality embryos when they are the only option for fresh embryo transfer (ET).