序贯移植在反复着床失败中的临床价值再评估

doi:10.12280/gjszjk.20260261

摘要/Abstract

摘要：

辅助生殖技术的核心目标是实现健康活产，然而，反复着床失败（recurrent implantation failure，RIF）仍是制约其疗效的关键瓶颈。序贯移植是指在同一个周期内先后移植卵裂胚和囊胚，为改善RIF患者妊娠结局提供了新思路。序贯移植主要通过3条途径改善子宫内膜容受性：胚胎来源的白血病抑制因子通过Janus激酶/信号转导及转录活化因子3通路上调同源框蛋白A10表达，增强胚胎-内膜黏附；雌、孕激素经基质细胞介导，通过纤维细胞生长因子-纤维细胞生长因子受体2信号轴调控上皮分化，参与种植窗的开启与关闭；机械刺激通过肿瘤坏死因子-α-基质金属蛋白酶信号通路促进血管新生，诱导M2型巨噬细胞极化，调节局部免疫微环境。临床证据显示，序贯移植在RIF、高龄、多囊卵巢综合征等特定人群中有一定的应用前景，且不增加多胎妊娠和异位妊娠的风险，但现有研究多为回顾性研究，随机对照试验数量有限，且不同研究在RIF定义、序贯方案设计等方面存在较大异质性，限制了证据的整合与推广。总体来看，现有证据尚不支持将序贯移植列为常规推荐方案，今后还需通过更精细的人群分层和前瞻性设计加以验证。

关键词: 序贯移植, 生殖技术, 辅助, 反复着床失败, 胚胎植入, 子宫内膜容受性, 妊娠结局

Abstract:

The core objective of assisted reproductive technology (ART) is to achieve a healthy live birth; however, recurrent implantation failure (RIF) remains a critical bottleneck limiting the clinical efficacy of ART. Sequential embryo transfer involves the transfer of a cleavage-stage embryo followed by a blastocyst within the same cycle, which offers a novel approach to improve the pregnancy outcomes in RIF patients. Sequential transfer improves endometrial receptivity primarily through three pathways: the embryo-derived leukemia inhibitory factors upregulate HOXA10 expression via the JAK/STAT3 signaling pathway, thereby enhancing embryo-endometrial adhesion; maternal estrogen and progesterone regulate epithelial differentiation through the FGFs-FGFR2 signaling axis that mediated by stromal cells, contributing to the opening and closure of the implantation window; and mechanical stimulation promotes angiogenesis via the TNF-α-MMP pathway while inducing M2-type macrophage polarization to modulate the local immune microenvironment. Clinically, sequential transfer has shown potential in specific populations, including those patients with RIF, advanced age, or polycystic ovary syndrome, without increasing the risks of multiple pregnancies or ectopic pregnancies. However, most current evidence is derived from the retrospective studies with limited randomized controlled trials, and considerable heterogeneity exists across studies regarding the definition of RIF and protocol design, which limits the integration and generalizability of the findings. Overall, current evidence does not support sequential transfer as the routine recommendation in RIF patients, and further studies with refined patient stratification and prospective design are needed to validate its clinical value.

Key words: Sequential embryo transfer, Reproductive techniques, assisted, Recurrent implantation failure, Embryo implantation, Endometrial receptivity, Pregnancy outcome

余照娟, 郭培培. 序贯移植在反复着床失败中的临床价值再评估[J]. 国际生殖健康/计划生育杂志, 2026, 45(5): 401-406.

YU Zhao-juan, GUO Pei-pei. Reassessment of Clinical Value on Sequential Embryo Transfer in Recurrent Implantation Failure[J]. Journal of International Reproductive Health/Family Planning, 2026, 45(5): 401-406.

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