胚胎移植技术对体外受精-胚胎移植结局的影响

The impact of the embryo transfer manipulation on the outcome of in vitro fertilization-embryo transfer

目的探讨胚胎移植过程的难易程度以及出血对体外受精-胚胎移植(IVF-ET)胚胎种植率及临床妊娠率的影响。方法回顾性分析我院生殖中心自2001年1月至2004年6月760个IVF-ET周期的胚胎移植技术与其临床结局的关系。结果760个胚胎移植周期中,胚胎移植容易403周期、较困难305周期、困难52周期,后者与前二者比较临床妊娠率和胚胎种植率分别下降了14.6%和5.5%,临床妊娠率下降有统计学差异(P<0.05);移植管无血染440周期、少量血染271周期、多量血染49周期,多量血染与无血染和少量血染比较,临床妊娠率和胚胎种植率分别下降了19.6%和7.3%,种植率下降有统计学差异(P<0.05)。结论胚胎移植是IVF-ET的关键步骤之一,移植过程应操作轻柔,减少困难胚胎移植和出血的发生,将会提高IVF-ET的临床妊娠率。

Objective： To investigate the influence of the difficulty of embryo transfer and blood found in the transfer catheter on the rates of clinical pregnancy and embryo implantation with the use of in vitro fertilization-embryo transfer （IVF-ET）. Methods： A cohort of 760 consecutive IVF-ET cycles in 710 patients in this hospital from January 2001 to June 2004 were retrospectively studied. The transfer manipulation was categorized into three degrees according to the difficulty： easy, intermediate and difficult. Results： The pregnancy rate and implantation rate of difficult transfers were 14. 6% and 5. 5% lower than those of easy-intermediate transfers, respectively. There was a statistical difference （P〈0.05） in clinical pregnancy rate. Significant blood found in the transfer catheter after ET was associated with decreased rates of clinical pregnancy and embryo implantation compared with no blood or minimal blood on the transfer catheter （18. 1% vs. 37. 7% and 11.1% vs. 18.4%, respectively）. Conclusions： The embryo transfer is a crucial step in IVF-ET. This study demonstrated that difficult transfer and much bleeding diminished the clinical pregnancy rate and implantation rate. All efforts should be made to avoid the difficult transfer and bleeding.