| BackgroundCurrently,it is common for women in our country to change their ideology and postpone the age of marriage and childbirth for career and personal development.Coupled with the full liberalization of my country’s two-child policy,more and more elderly women want to get pregnant,and more patients seek assisted reproductive technology(ART)help.With the rapid development of ART,it is essential to solving iatrogenic complications caused by ART—multiple pregnancies is particularly important.The whole world is striving to control the number of embryos transferred in each cycle to reduce multiple pregnancy occurrences.How can we increase the pregnancy rate and reduce the multiple birth rate and finding a coordinated method have become a problem that ART needs to solve urgently.At present,there is no consensus on whether to transplant one or two embryos for elderly women at home and abroad.This study retrospectively analyzed the pregnancy outcome of different numbers of blastocysts transplanted in elderly women in IVF/ICSI,and compared the benefits and risks.It guides clinicians to make decisions while obtaining safe and best treatment results for patients.MethodsThe clinical data of infertile patients who were treated at the Reproductive Center of Northwest Women and Children’s Hospital of Shaanxi Province from January 1,2014,to December 31,2018,and were treated with IVF/ICSI were obtained to derive their clinical data and follow-up until February 2020 On the 29 th.Inclusion criteria: All infertile women undergoing IVF/ICSI treatment for the first fresh or freeze-thaw cycle blastocyst transfer.Exclusion criteria: age <35 years;patients with more than 2blastocysts transplanted(n=6);uterine malformations and severe medical diseases are not suitable for pregnancy;scarred uterus(n=214);height <150cm;abnormal pelvic development;those who underwent preimplantation genetic testing(PGT);patients with incomplete information included.After passing the inclusion and exclusion criteria,a total of 2323 egg retrieval cycles entered the study and analysis.The patients were divided into 5 groups according to their ages,including 35-36 years old,37-38 years old,39-40 years old,41-42 years old,≥43 years old,and statistically analyzed the pregnancy outcome of transplantation of 1 or 2 blastocysts in each age group.Including the leading outcome indicators: live birth rate,secondary outcome indicators: clinical pregnancy rate,multiple pregnancy rate,and abortion rate.Results(1)After IVF/ICSI assisted fertility treatment,a total of 2543 cycles met the inclusion criteria,and 220 cycles were excluded.The current 2323 cycles entered the study.There were 1041 cycles of live birth,the live birth rate was 44.81%;1371 cycles of clinical pregnancy,the clinical pregnancy rate was 59.02%,of which 213 cycles of multiple pregnancy clinical pregnancy,accounting for 15.54%;and 330 cycles of abortion,accounting for 24.07%.(2)The type of infertility,the cause of infertility and the method of insemination have no significant influence on the pregnancy outcome.(3)In the 35-36 years old,37-38 years old,and 39-40 years old groups,the live birth rate of transplanting two blastocysts was higher than that of transplanting one(respectively,58.45% vs.45.44%,P <0.001;57.38%vs.44.84%,P=0.002;50.00%vs.26.76%,P<0.001),all of which were statistically different.At the same time,in the above age groups,the multiple birth rate of transplanting two blastocysts was significantly higher than that of transplanting one(37.69% vs.3.37%;31.18% vs.1.32%;34.41% vs.3.45),and there were statistical differences(P<0.001).(4)In the 35-36 years old,37-38 years old,and 39-40 years old groups,the live birth rate of transplanting 2 high-quality blastocysts was higher than that of transplanting 1 high-quality blastocyst(respectively,75.51% vs.52.03%,P= 0.001;74.19% vs.54.30,P=0.034;72.22% vs.37.86,P=0.004),all of which were statistically different.the live birth rate of transplanting 1 high-quality 1 non-high-quality,and 2non-high-quality blastocysts was higher than that of transplanting 1 high-quality blastocyst(respectively,64.37%vs.52.03%,P=0.032;57.38%vs.52.03%,P=0.177.59.26%vs.54.30%,P=0.504;53.29%vs.54.30%,P=0.845 52.78%vs.37.86%,P=0.093;44.05%vs.37.86%,P=0.359),except for the transplantation of 1 high-quality 1non-high-quality blastocyst,the live birth rate was higher than that of 1 high-quality blastocyst.Except for statistical difference,there were no statistical differences among the remaining groups.The multiple birth rates of transplanting 2 high-quality,1high-quality 1 non-high-quality,and 2 non-high-quality blastocysts were higher than that of transplanting 1 high-quality(respectively,46.34% vs.2.11%,P<0.001;36.23%vs.2.11)%,P <0.001;36.08% vs.2.11%,P <0.001.48.28% vs.1.35%,P <0.001;45.45% vs.1.35%,P <0.001;23.71% vs.1.35%,P = 0.122.35.71%vs.3.57%,P=0.001;42.31%vs.3.57%,P < 0.001;30.19%vs.3.57%,P=0.018),except for the transplantation of 2 non-high-quality blastocyst in the 37-38 years old group,the multiple birth rate was higher than that of 1 high-quality blastocyst.Except for no statistical difference,there were statistical differences among the remaining groups.(5)Compared with the other groups,the live birth rate in the two groups of 41-42 years old and ≥43 years old was greatly reduced.The live birth rate of transplanting two blastocysts in the 41-42 years group was higher than that of transplanting one blastocyst(36.84% vs.13.95%,P=0.001),there was a statistical difference;the live birth rate of transplanting two blastocysts in the group of ≥43 years old was similar to that of transplanting one blastocyst(12.90% vs.15.56%,P =0.738),there was no statistical difference.The multiple birth rate of transplanting two blastocysts in the 41-42 years old group was higher than that of transplanting one(21.43% vs.0,P=0.001),which was statistically different.There was no multiple pregnancy when one or two blastocysts were transplanted in the≥43 years old group.(6)In the 41-42-year-old group,only 1 high-quality 1 non-high-quality,and 2non-high-quality blastocysts were transplanted to produce multiple pregnancy.Compared with the transplantation of 1 high-quality blastocyst,the multiple pregnancy rate was higher(respectively,11.11% vs.0,P=0.207;29.41% vs.0,P=0.176),there was no statistical difference;in this group ≥ 43 years old,there were no multiple pregnancy.(7)In order to control the multiple birth rate below 20%,just the multiple birth rate was 0 and the live birth rate was about 10% for women over 43 years old.The multiple birth rate for women aged 41-42 years old was 21.43%,close to 20%,and the live birth rate was higher than 35%.ConclusionIn clinical IVF/ICSI assisted fertilization for elderly women,it is recommended that elderly infertile women choose to transplant 1 blastocyst as much as possible,regardless of whether they have high-quality blastocysts.Not only ensures a higher live birth rate,but also avoids the risk of multiple pregnancies and improves the pregnancy outcome... |
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