Comparison Of Clinical Outcomes Of Different Embryo Transfer Protocols In Patients With Repeated Implantation Failure In Frozen-thawed Cycles

Objective: The study compared the embryo implantation rate,clinical pregnancy rate,biochemical pregnancy rate,miscarriage rate,multiple pregnancy rate and ectopic pregnancy rate among cleavage stage embryo transfer,two-step embryo transfer and blastocyst transfer in frozen-thawed cycles.To provide the clinical guidance for the patients with repeated implantation failure(RIF)to make a appropriate embryo transfer protocol.Methods: In this retrospective study,A total of 252 patients with RIF were undergoing the frozen-thawed embryo transfer(FET)treatment in the reproductive center of the First People's Hospital of Changde from August 2014 to August 2016.Involving 280 transplant cycles,including 182 cycles of cleavage stage embryo transfers(D3 group),72 cycles of two-step embryo transfer(D3/D5 group)and 26 cycles of blastocyst transfer(D5 group).Groups were compared including implantation rate,clinical pregnancy rate,biochemical pregnancy rate,miscarriage rate,multiple pregnancy rate and ectopic pregnancy rate.Results: 1.There were no significant differences among three groups in age,infertility duration,infertility type and endometrial preparation protocols(P >0.05).2.No statistically differences existed in regard to embryo resuscitation rate among three groups.The rate of optimal embryo after resuscitation of D3/D5 group were lower than those of D3 group(72.46%vs.81.20%),showing significant differences(P <0.05),but no significant difference were found between group D3/D5 and D5,D3 and D5(P>0.05).3.D3 group and D3/D5 group were transplanted three embryos,and D5 group were transplanted two embryos.The implantation rate of embryos in D5 group was significantly higher than that in group D3(38.46% vs.21.61%)(P <0.05),and there was no significant difference between D5 group and D3 / D5 group,the same as the D3 / D5 group and D3 group(P> 0.05),but the former had higher trend than the latter group.The clinical pregnancy rate of D3/D5 group was significantly higher than that of D3 group(62.50%vs.45.09%)(P<0.05),the D5 group had an increasing trend compared to the D3 group(57.69%vs.45.09%),and there was no significant difference between the other two groups(P> 0.05).No statistically differences existed in regard to the biochemical pregnancy rate among three groups,however,the D3/ D5 group than the D3 group(68.06%vs.53.30%),and D5 group than the D3 group(65.38%vs.53.30%)showed an increasing trend.4.No statistically differences existed in regard to abortion and multiple pregnancy rate among three groups(P<0.05).No case of ectopic pregnancy occurred in D3/D5 group and D5 group,while in the D3 group,there were 4 cases of ectopic pregnancy,3 cases of intrauterine pregnancy with ectopic pregnancy.5.Both D3/D5 group and D5 group were cultured in blastocysts.The rate of optimal embryos to be cultured in blastocysts of D3/D5 group was significantly lower than that of group D5(53.20%vs.77.42%),and the rate of blastocyst formation was significantly lower than that of the latter(37.44%vs.59.14%)(P<0.05).Conclusions: For RIF patients in the recovery period,two-step embryo transfer and blastocyst transfer can obtain better embryo implantation rate,clinical pregnancy rate,and miscarriage rate,multiple pregnancy rate and ectopic pregnancy rate compared with cleavage stage embryo transfer did not increase.When the number of available embryos is more than or equal to 3,especially the ratio of optimal embryo is relatively low,it is advisable to select the two-step embryo transfe strategy.And for those who have a high risk of ectopic pregnancy patients,the blastocyst transfer may also be considered in fully informing the risk of blastula culture.