重新审视全胚冷冻的获益人群：一项超过9000例胚胎移植的匹配队列分析
该研究为英国单中心回顾性匹配分析，纳入2016至2023年间9923次自体取卵和9716次胚胎移植，比较新鲜移植与全胚冷冻后首次移植的活产结局。结果显示，低反应者（获卵少于6枚）两种策略活产率相当，低胚胎产出周期（少于3枚胚胎）全胚冷冻显著改善活产，而高反应者中新鲜移植有更高结局但差异不显著。
要点
- 低胚胎产出周期（少于3枚胚胎）全胚冷冻后活产率显著优于新鲜移植（aOR 1.6）。
- 低反应者（获卵少于6枚）新鲜与冷冻首次移植活产率无差异（26% vs 27%）。
- 高反应者（≥16枚卵）及高胚胎产出周期中新鲜移植结局更高但差异不显著。
核心结论
- 全胚冷冻可能改善低胚胎产出周期及年轻患者中劣质胚胎的活产结局，但需验证性分析。
研究设计与样本
- 英国单中心回顾性匹配分析，纳入2016至2023年9923次自体取卵和9716次胚胎移植。
- 评估每个周期首次胚胎移植结局，并另行分析单次取卵多次移植的活产风险比，新鲜移植周期4202次累计活产1664例，全胚冷冻周期2312次累计活产1354例。
主要发现
- 按年龄分层，活产比值无差异。
- 低反应者（获卵少于6枚）新鲜与首次冷冻移植活产率相当（aOR 1，95%CI 0.7-1.5；26% vs 27%；P=1）。
- 高反应者（≥16枚卵）及高胚胎产出周期（≥5枚胚胎）新鲜移植结局更高但差异不显著。
- 低胚胎产出周期（少于3枚胚胎）控制胚胎质量后全胚冷冻显著改善结局（aOR 1.6，95%CI 1.2-2.1；38% vs 29%；P=0.02），≥38岁患者可能获益更大。
- 劣质胚胎移植中，<38岁患者全胚冷冻活产比值增加2倍，但校正后失去显著性。
关键数值与推荐
- 低胚胎产出周期（少于3枚胚胎）全胚冷冻aOR 1.6（95%CI 1.2-2.1），活产率38% vs 29%，P=0.02。
- 低反应者（获卵少于6枚）aOR 1（95%CI 0.7-1.5），活产率26% vs 27%，P=1。
临床怎么用
- 对低胚胎产出周期（少于3枚胚胎）可优先考虑全胚冷冻策略。
- 低反应者（获卵少于6枚）新鲜与冷冻移植活产率相当，决策需个体化。
- 高反应者及高胚胎产出周期中新鲜移植结局更高但差异不显著，不宜常规推荐全胚冷冻。
局限性
- 回顾性单中心设计，存在选择偏倚可能。
- 劣质胚胎亚组中全胚冷冻的获益在校正后失去显著性，需谨慎解读。
- 结论需验证性分析确认。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
RESEARCH QUESTION: Is a fresh embryo transfer superior to a frozen embryo transfer after a freeze-all approach in achieving a live birth in IVF cycles? DESIGN: A retrospective matched analysis of 9923 autologous oocyte retrievals and 9716 embryo transfers performed between 2016 and 2023 at a single UK centre was undertaken. Patients underwent a fresh transfer or the decision was made to freeze all embryos. First embryo transfer outcomes from each cycle were assessed, and a separate analysis was undertaken to assess the hazard ratio of live birth across multiple embryo transfers arising from a single oocyte retrieval, with 1664 cumulative live births after 4202 fresh transfer cycles and 1354 cumulative live births after 2312 freeze-all embryo cycles. RESULTS: No difference in the odds of live birth was seen when stratifying by age. Among low responders (fewer than six oocytes), fresh and first frozen embryo transfers demonstrated comparable live birth rates [adjusted OR (aOR) 1, 95% CI 0.7-1.5; 26% versus 27%; P = 1]. In high responders (≥16 oocytes) and high-embryo-yield cycles (five embryos or more), higher outcomes were observed in fresh transfers, but the difference was non-significant. Low-embryo-yield cycles (fewer than three embryos) were associated with significantly improved outcomes after a freeze-all approach controlled for embryo quality (aOR 1.6, 95% CI 1.2-2.1; 38% versus 29%; P = 0.02), with potential greater benefit for patients aged ≥38 years. In transfers of suboptimal-grade embryos, the freeze-all approach was associated with a 2-fold increase in the odds of live birth in patients aged <38 years, but this lost significance after correction. Cumulatively, while a higher live birth rate was observed for fresh cycles compared with freeze-all cycles in patients aged <38 years, overall there was no significant difference in the live birth rate per cycle. CONCLUSIONS: A freeze-all approach may improve outcomes in low-embryo-yield cycles and in younger patients with suboptimal-grade embryos, but confirmatory analyses are required.
引用
- Garratt J, Macklon N, Ellis PJ, et al. Time to reconsider who the freeze-all approach benefits: a matched cohort analysis of over 9000 embryo transfers. Reprod Biomed Online. 2026. PMID: 42400998. doi:10.1016/j.rbmo.2026.105742
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。