体外受精中非优质胚胎的最佳移植策略探讨
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摘要
目的探讨体外受精-胚胎移植中非优质胚胎的最佳移植策略。方法回顾性分析成都市妇女儿童中心医院2014~2015年首次移植胚胎全部为非优质胚胎的周期资料共550例,其中冻融非优质胚胎移植组157例,新鲜非优质胚胎移植组393例,分析两组患者的临床结局。结果冻融周期的临床妊娠率(43.31%)比新鲜周期(34.86%)更高(P<0.05);两组胚胎种植率、流产率比较差异均无统计学意义(P>0.05);胚胎碎片原因形成的非优质胚胎在冻融周期的临床妊娠率、胚胎种植率均显著高于发育速度异常的非优质胚胎(P<0.05)。结论冻融胚胎移植可改善非优质胚胎患者的临床结局,特别是以胚胎碎片原因形成的非优质胚胎。
Objective To investigate a better embryo transfer strategy for non-top quality embryos in in-vitro fertilization and embryo transfer(IVF-ET).Methods A retrospective analysis was performed for the clinical data of non-top quality embryos in 550 IVF-ET cycles,including 157 frozen-thawed embryo transfer(FET) cycles and 393 fresh embryo transfer(ET) cycles in Chengdu Women & Children's Central Hospital from January 2014 to December 2015.Results The clinical pregnancy rate of non-top quality embryos in FET cycle was significantly higher than in ET cycle [(43.31 % vs.34.86 %),P<0.05 ];There were no significant differences in implantation rate and abortion rate between the two groups(P>0.05);For non-top quality embryos caused by embryo debris in FET cycle,the clinical pregnancy rate and embryo implantation rate were significantly higher than those of non-top quality embryos with abnormal developmental speed(P<0.05).Conclusion The use of FET can improve the clinical outcomes for non-top quality embryos,especial for those caused by embryo debris.
Objective To investigate a better embryo transfer strategy for non-top quality embryos in in-vitro fertilization and embryo transfer(IVF-ET).Methods A retrospective analysis was performed for the clinical data of non-top quality embryos in 550 IVF-ET cycles,including 157 frozen-thawed embryo transfer(FET) cycles and 393 fresh embryo transfer(ET) cycles in Chengdu Women & Children's Central Hospital from January 2014 to December 2015.Results The clinical pregnancy rate of non-top quality embryos in FET cycle was significantly higher than in ET cycle [(43.31 % vs.34.86 %),P<0.05 ];There were no significant differences in implantation rate and abortion rate between the two groups(P>0.05);For non-top quality embryos caused by embryo debris in FET cycle,the clinical pregnancy rate and embryo implantation rate were significantly higher than those of non-top quality embryos with abnormal developmental speed(P<0.05).Conclusion The use of FET can improve the clinical outcomes for non-top quality embryos,especial for those caused by embryo debris.
引文
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[11]张轶乐,孙婧,苏迎春,等.新鲜和冻融胚胎移植妇女异位妊娠的发生率及其影响因素[J].中华妇产科杂志,2012,47(9):655-658.
[12]徐维海,竺海燕,童晓嵋,等.体外受精获得全部非优质胚胎周期的移植策略分析[J].中华医学杂志,2011,91(31):2208-2210.
[13]许丽娟,陈薪,田小龙,等.非优良胚胎形成的囊胚与卵裂期优良胚胎的冻融胚胎移植的临床结局比较[J].南方医科大学学报,2015,35(4):481-485.
[14]SHAW-JACKSON C,BERTRAND E,BECKER B,et al.Vitrification of blastocysts derived from fair to poor quality cleavage stage embryos can produce high pregnancy rates after warming[J].Journal of Assisted Reproduction and Genetics,2013,30(8):1035-1042.
[2]CHEN Hong,QIAN Kun,HU Juan,et al.The derivation of two additional human embryonic stem cell lines from day 3 embryos with low morphological scores[J].Human Reproduction(Oxford,England),2005,20(8):2201-2206.
[3]薛林涛,黄莉,何冰,等.体外受精治疗周期中剩余胚胎囊胚培养的临床价值[J].中国临床新医学,2010,3(1):23-27.
[4]丁锦丽,杨菁,张艳,等.D 3非优质胚胎的冷冻价值及其临床结局分析[J].生殖医学杂志,2015,24(4):267-271.
[5]柳朝华,高士友,邓朝晖,等.形态正常但发育滞后的非优质胚胎移植的妊娠结局[J].医学临床研究,2015,32(3):552-554.
[6]周瑞年,王雪梅.降调后血清雌激素水平预测IVF结局的价值[J].四川医学,2011,32(4):510-512.
[7]庄广伦.现代辅助生育技术[M].北京:人民卫生出版社,2005:240-241.
[8]邓莲,李永刚,马艳萍,等.体外受精-胚胎移植中非优质胚胎的冷冻价值[J].生殖医学杂志,2012,21(3):230-233.
[9]BASIR G S,O W S,NG E H,et al.Morphometric analysis of peri-implantation endometrium in patients having excessively high oestradiol concentrations after ovarian stimulation[J].Human Reproduction(Oxford,England),2001,16(3):435-440.
[10]宋韬,刘柳,周枫,等.冻融胚胎移植替代新鲜胚胎移植提高体外受精-胚胎移植临床妊娠率的探讨[J].中华医学杂志,2009,89(41):2928-2930.
[11]张轶乐,孙婧,苏迎春,等.新鲜和冻融胚胎移植妇女异位妊娠的发生率及其影响因素[J].中华妇产科杂志,2012,47(9):655-658.
[12]徐维海,竺海燕,童晓嵋,等.体外受精获得全部非优质胚胎周期的移植策略分析[J].中华医学杂志,2011,91(31):2208-2210.
[13]许丽娟,陈薪,田小龙,等.非优良胚胎形成的囊胚与卵裂期优良胚胎的冻融胚胎移植的临床结局比较[J].南方医科大学学报,2015,35(4):481-485.
[14]SHAW-JACKSON C,BERTRAND E,BECKER B,et al.Vitrification of blastocysts derived from fair to poor quality cleavage stage embryos can produce high pregnancy rates after warming[J].Journal of Assisted Reproduction and Genetics,2013,30(8):1035-1042.