解冻移植不同时期胚胎与单卵双胎发生率的相关性分析
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摘要
目的比较分析解冻移植周期中处于不同阶段胚胎的单卵双胎(MZT)发生率,可通过避免移植内细胞团松散的囊胚来减少单卵双胎的发生。方法回顾性分析2013-2015年在广州医科大学附属第三医院生殖中心解冻移植的5 069周期、临床妊娠2 724周期情况。根据移植的胚胎情况分为卵裂胚组、桑椹胚组、囊胚组,比较分析卵裂胚组、桑椹胚组、囊胚组的MZT发生情况与临床结局。结果本研究共观察到96例MZT,总的MZT发生率为3. 5%(96/2 724)。卵裂胚组MZT发生率1. 2%(9/737),桑椹胚组MZT发生率2. 5%(3/122),囊胚组MZT发生率4. 5%(84/1 865),3组之间的MZT发生率比较差异有统计学意义(P<0. 05)。结论胚胎的继续培养至囊胚容易增加单卵双胎的发生比例。避免移植内细胞团松散的囊胚可帮助减少单卵双胎妊娠的发生。
Objective To compare and analyze the incidence rate of monozygotic twins( MZT) of embryo in different stages of frozen thawed embryo transfer,reduce the occurrence of MZT by avoiding blastocysts that contain decompacting ICMs. Methods The data of 5 069 frozen thawed embryo transfer cycles( 2 724 cycles of clinical pregnancy) were analyzed retrospectively in Reproductive Medicine Center of the Third Affiliated Hospital of Guangzhou Medical University from 2013 to 2015. The cases were divided into cleavage embryo group,morula group,and blastocyst group according to the transferred embryo. The incidence rates of MZT and clinical outcomes in the three groups were compared and analyzed. Results The total incidence rate of MZT was 3. 5%( 96/2 724). The incidence rates of MZT in embryo group,morula group,and blastocyst group were 1. 2%( 9/737),2. 5%( 3/122),and 4. 5%( 84/1 865),respectively,there was statistically significant difference among the three groups( P<0. 05). Conclusion Blastocyst culture is associated with an increased risk of MZT,excluding blastocysts that contain decompacting ICMs may avoid the occurrence of MZT.
Objective To compare and analyze the incidence rate of monozygotic twins( MZT) of embryo in different stages of frozen thawed embryo transfer,reduce the occurrence of MZT by avoiding blastocysts that contain decompacting ICMs. Methods The data of 5 069 frozen thawed embryo transfer cycles( 2 724 cycles of clinical pregnancy) were analyzed retrospectively in Reproductive Medicine Center of the Third Affiliated Hospital of Guangzhou Medical University from 2013 to 2015. The cases were divided into cleavage embryo group,morula group,and blastocyst group according to the transferred embryo. The incidence rates of MZT and clinical outcomes in the three groups were compared and analyzed. Results The total incidence rate of MZT was 3. 5%( 96/2 724). The incidence rates of MZT in embryo group,morula group,and blastocyst group were 1. 2%( 9/737),2. 5%( 3/122),and 4. 5%( 84/1 865),respectively,there was statistically significant difference among the three groups( P<0. 05). Conclusion Blastocyst culture is associated with an increased risk of MZT,excluding blastocysts that contain decompacting ICMs may avoid the occurrence of MZT.
引文
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[12]Vitthala S,Gelbaya TA,Brison DR,et al. The risk of monozygotic twins after assisted reproductive technology:a systematic review and meta-analysis[J].Hum Reprod Update,2009,15(1):45-55.
[13]Kawachiya S,Bodri D,Shimada N,et al. Blastocyst culture is associated with an elevated incidence of monozygotic twinning after single embryo transfer[J]. Fertil Steril, 2011, 95(6):2140-2142.
[14]Knopman JM,Krey LC,Oh C,et al. What makes them split? Identifying risk factors that lead to monozygotic twins after in vitro fertilization[J]. Fertil Steril,2014,102(1):82-89.
[15]Mateizel I,Santos-Ribeiro S,Done E,et al. Do ARTs affect the incidence of monozygotic twinning?[J]. Hum Reprod,2016,31(11):2435-2441.
[16]Otsuki J,Iwasaki T,Katada Y,et al. Grade and looseness of the inner cell mass may lead to the development of monochorionic diamniotic twins[J]. Fertil Steril,2016,106(3):640-644.
[17]Derom C,Leroy F,Vlietinck R,et al. High frequency of iatrogenic monozygotic twins with administration of clomiphene citrate and a change in chorionicity[J]. Fertil Steril, 2006, 85(3):755-757.
[2]Blickstein I. Estimation of iatrogenic monozygotic twinning rate following assisted reproduction:pitfalls and caveats[J]. Am J Obstet Gynecol,2005,192(2):365-868.
[3]Aston KI,Peterson CM,Carrell DT. Monozygotic twinning associated with assisted reproductive technologies:a review[J]. Reproduction,2008,136(4):377-386.
[4]Sebire NJ,Snijders RJM,Hughes K,et al. The hidden mortality of monochorionic twin pregnancies[J]. Br J Obstet Gynaecol,1997,104(10):1203-1207.
[5]Adegbite AL,Castille S,Ward S,et al. Neuromorbidity in preterm twins in relation to chorionicity and discordant birth weight[J]. Am J Obstet Gynecol,2004,190(1):156-163.
[6]Rao A,Sairam S,Shehata H. Obstetric complications of twin pregnancies[J]. Best Pract Res Clin Obstet Gynaecol, 2004, 18(4):557-576.
[7]Moayeri SE,Behr B,Lathi RB,et al. Risk of monozygotic twinning with blastocyst transfer decreases over time:an 8-year experience[J]. Fertil Steril,2007,87(5):1028-1032.
[8]Chang HJ,Lee JR,Jee BC,et al. Impact of blastocyst transfer on offspring sex ratio and the monozygotic twinning rate:a systematic review and meta-analysis[J]. Fertil Steril, 2009, 91(6):2381-2390.
[9]Bulmer MG. The biology of twinning in man[J]. J Med Genet,1970,7(4):426.
[10]刘见桥,庄广伦,龙晓林,等.原核形态、卵裂胚发育与染色体异常关系的研究[J].中国实用妇科与产科杂志,2008,24(5):372-374.
[11]李莉,龙晓林,姚瑞芬,等.体外受精—胚胎移植周期中单卵双胎妊娠分析[J].中国实用妇科与产科杂志,2010,26(9):701-704.
[12]Vitthala S,Gelbaya TA,Brison DR,et al. The risk of monozygotic twins after assisted reproductive technology:a systematic review and meta-analysis[J].Hum Reprod Update,2009,15(1):45-55.
[13]Kawachiya S,Bodri D,Shimada N,et al. Blastocyst culture is associated with an elevated incidence of monozygotic twinning after single embryo transfer[J]. Fertil Steril, 2011, 95(6):2140-2142.
[14]Knopman JM,Krey LC,Oh C,et al. What makes them split? Identifying risk factors that lead to monozygotic twins after in vitro fertilization[J]. Fertil Steril,2014,102(1):82-89.
[15]Mateizel I,Santos-Ribeiro S,Done E,et al. Do ARTs affect the incidence of monozygotic twinning?[J]. Hum Reprod,2016,31(11):2435-2441.
[16]Otsuki J,Iwasaki T,Katada Y,et al. Grade and looseness of the inner cell mass may lead to the development of monochorionic diamniotic twins[J]. Fertil Steril,2016,106(3):640-644.
[17]Derom C,Leroy F,Vlietinck R,et al. High frequency of iatrogenic monozygotic twins with administration of clomiphene citrate and a change in chorionicity[J]. Fertil Steril, 2006, 85(3):755-757.
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