复苏周期单囊胚移植与双囊胚、双卵裂胚移植的临床结局比较
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摘要
目的探讨复苏周期单囊胚移植与双囊胚、双卵裂胚移植的不同临床结局。方法回顾性分析2016年1~12月在本中心第一次行FET,年龄≤38岁的320例患者的临床结局。其中单囊胚组98例,双囊胚组90例,双卵裂胚组132例,比较各组患者的临床妊娠率、胚胎着床率和多胎率。结果单囊胚组和双卵裂胚组患者的临床妊娠率均低于双囊胚组,差异有统计学意义(P<0.05)。单囊胚组和双囊胚组患者的胚胎着床率均显著高于双卵裂胚组,差异有统计学意义(P<0.01)。单囊胚组患者的多胎率显著低于双囊胚组及双卵裂胚组,差异有统计学意义(P<0.05)。结论对年龄≤38岁的患者,建议其第一次冻融移植周期行单囊胚移植,在显著降低多胎率的同时能够获得与双卵裂胚相似甚至更好的临床结局;不建议移植双囊胚,以避免过高的多胎率。
Objective To discuss the different clinical outcomes of single blastocyst transplantation,double blastocyst and double cleavage embryo transplantation.Methods The clinical outcomes of 320 patients with first implementation of FET and the age of no more than 38 years old from January to December 2016 in our center were retrospectively analyzed.All patients were divided into single blastocyst transplantation group(n =98),double blastocyst transplantation group(n=90) and double cleavage embryo transplantation group(n=132).The clinical pregnancy rate,embryo implantation rate and multiple pregnancy rate among three groups were compared.Results The clinical pregnancy rate of the single blastocyst transplantation group and the double cleavage transplantation group were lower than the double blastocyst transplantation group,and the differences were statistically significant(P<0.05).The rate of embryo implantation in the single blastocyst transplantation group and the double blastocyst transplantation group were significantly higher than that in the double cleavage embryo transplantation group,and the difference was statistically significant(P <0.01).The multiple pregnancy rate of single blastocyst transplantation group was significantly lower than the double blastocyst transplantation group and the double cleavage embryo transplantation group,the difference was statistically significant(P <0.05).Conclusion For patients whose age no more than 38 years old,the first freeze-thaw transplantation cycle is recommended for single blastocyst transplantation which can obtain a similar clinical outcome or even better compared with double cleavage embryo transplantation,at the same time significantly decreases the multiple birth rate.The double blastocyst transplantation is not advisable in order to avoid too high multiple pregnancy rate.
Objective To discuss the different clinical outcomes of single blastocyst transplantation,double blastocyst and double cleavage embryo transplantation.Methods The clinical outcomes of 320 patients with first implementation of FET and the age of no more than 38 years old from January to December 2016 in our center were retrospectively analyzed.All patients were divided into single blastocyst transplantation group(n =98),double blastocyst transplantation group(n=90) and double cleavage embryo transplantation group(n=132).The clinical pregnancy rate,embryo implantation rate and multiple pregnancy rate among three groups were compared.Results The clinical pregnancy rate of the single blastocyst transplantation group and the double cleavage transplantation group were lower than the double blastocyst transplantation group,and the differences were statistically significant(P<0.05).The rate of embryo implantation in the single blastocyst transplantation group and the double blastocyst transplantation group were significantly higher than that in the double cleavage embryo transplantation group,and the difference was statistically significant(P <0.01).The multiple pregnancy rate of single blastocyst transplantation group was significantly lower than the double blastocyst transplantation group and the double cleavage embryo transplantation group,the difference was statistically significant(P <0.05).Conclusion For patients whose age no more than 38 years old,the first freeze-thaw transplantation cycle is recommended for single blastocyst transplantation which can obtain a similar clinical outcome or even better compared with double cleavage embryo transplantation,at the same time significantly decreases the multiple birth rate.The double blastocyst transplantation is not advisable in order to avoid too high multiple pregnancy rate.
引文
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[8]马龙,钱晓乔,蔡令波,等.全胚冷冻再行解冻胚胎移植周期的临床结局分析[J].生殖与避孕,2012,32(4):237-240.
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[10]郝桂琴,李蓉,耿岚,等.胚胎移植与囊胚移植的临床结局分析[J].中国组织工程研究与临床康复,2011,15(31):5739-5742.
[11]Thoms MR,Sparks AE,Ryan GL,et al.Clinical predictors of human blastocyst formation and pregnancy after extended embryo culture and transfer[J].Fertil steril,2010,94(2):543-548.
[12]Saki G,Rahim F,Moradi L.The study of developmental capacity of vitrified mouse blastocsts in different straws after transfer to mouse pseudo pregnant[J].Pak J Biol Sci,2008,11(14):1809-1814.
[13]Yanaihara A,Yorimitsu T,Motoyama H,et al.Clinical outcome of frozen blastocyst transfer;single vs.double transfer[J].J Assist Reprod Genet,2008,25(11-12):531-534.
[14]张波,冯贵雪,周虹,等.选择性单囊胚移植在降低多胎率中的应用[J].国际生殖健康/计划生育杂志,2012,32(1):38-41.
[15]陈攀宇,方丛,贾磊,等.复苏周期D5单囊胚移植与双囊胚移植对妊娠结局的影响[J].生殖医学杂志,2016,25(12):1049-1053.
[2]董耘,高颖.多胎减胎术的应用进展[J].现代妇产科进展,2013,22(5):422-424.
[3]Kang SM,Lee SW,Yoon SH,et al.Comparison of clinical outcomes between single and double vitrified-ward blastocyst embryo transfer according to the day of vitrification[J].Fertil Steril,J assist Reprod Genet,2013,30(6):779-785.
[4]Brinsden PR.A textbook of in vitro fertilization and assisted reproduction[M].New York:The part heno Publishing Group Inc,1999:196.
[5]Gardner D,Lane MJ,Schlenker T,et al.Blastocyst score affects implantation and pregnancy outcome:towards a single blastocyst transfer[J].Fertil Steril,2000,73(6):1155-1158.
[6]Ishihara O,Araki R,Kuwahara A,et al.Impact of frozenthawed single-blastocyst transfer on maternal and neonatal outcome:an analysis of 277 042 single-embryo transfer cycles from 2008 to 2010 in Japan[J].Fertil Steril,2014,101(5):128-133.
[7]Goto S,Kadowaki T,Tanaka S,et al.Prediction of pregnancy rate by blastocyst morphologi-cal score and age,based on1488 single frozen-thawed blastocyst transfer cycles[J].Fertil Steril,2011,95(3):948-952.
[8]马龙,钱晓乔,蔡令波,等.全胚冷冻再行解冻胚胎移植周期的临床结局分析[J].生殖与避孕,2012,32(4):237-240.
[9]赵静,张媔秋,张军强,等.玻璃化冷冻囊胚复苏移植与新鲜囊胚移植的临床结局比较[J].南京医科大学学报(自然科学版),2014,37(1):41-43.
[10]郝桂琴,李蓉,耿岚,等.胚胎移植与囊胚移植的临床结局分析[J].中国组织工程研究与临床康复,2011,15(31):5739-5742.
[11]Thoms MR,Sparks AE,Ryan GL,et al.Clinical predictors of human blastocyst formation and pregnancy after extended embryo culture and transfer[J].Fertil steril,2010,94(2):543-548.
[12]Saki G,Rahim F,Moradi L.The study of developmental capacity of vitrified mouse blastocsts in different straws after transfer to mouse pseudo pregnant[J].Pak J Biol Sci,2008,11(14):1809-1814.
[13]Yanaihara A,Yorimitsu T,Motoyama H,et al.Clinical outcome of frozen blastocyst transfer;single vs.double transfer[J].J Assist Reprod Genet,2008,25(11-12):531-534.
[14]张波,冯贵雪,周虹,等.选择性单囊胚移植在降低多胎率中的应用[J].国际生殖健康/计划生育杂志,2012,32(1):38-41.
[15]陈攀宇,方丛,贾磊,等.复苏周期D5单囊胚移植与双囊胚移植对妊娠结局的影响[J].生殖医学杂志,2016,25(12):1049-1053.