年龄及移植优质胚胎数对体外受精-胚胎移植患者多胎妊娠率的影响

Influence of patient age and the number of good-quality-embryos transferred on multiple gestation in in vitro fertilization and embryo transfer

目的研究年龄及移植优质胚胎数对体外受精一胚胎移植（IVF-ET）患者多胎妊娠发生率的影响。方法回顾性分析2004年1月至2006年11月，在中南大学中信湘雅生殖与遗传专科医院行新鲜胚胎移植的不孕症患者共4395个周期，按患者年龄分为年龄〈35岁组（3442个周期）和年龄／〉35岁组（共953个周期）。每个周期常规移植2—3枚胚胎，仅有1枚可移植胚胎者移植1枚胚胎，年龄／〉35岁或第2次移植且只有2枚胚胎者移植2枚胚胎。统计各组所有周期的临床妊娠及多胎妊娠率。结果（1）年龄〈35岁组移植1枚胚胎者的临床妊娠率[29．64％（166／560）]低于移植2、3枚者[分别为51．63％（1315／2547）、52．84％（177／335）]，差异均有统计学意义（P〈0．01）；移植2枚与3枚者比较，差异无统计学意义（P〉0．05）。3者的多胎妊娠率分别为21．08％（35／166）、31．41％（413／1315）和42．37％（75／177），两两比较，差异均有统计学意义（P〈0．01）。（2）年龄≥35岁组移植1枚胚胎者的临床妊娠率[19．07％（41／215）]低于移植2、3枚者[分别为33．70％（92／273）、39．14％（182／465）]，差异均有统计学意义（P〈0．01）；移植2枚与3枚者比较，差异无统计学意义（P〉0．05）。移植1枚和2枚胚胎者的多胎妊娠率[分别为19．51％（8／41）和20．65％（19／92）]比较，差异无统计学意义（P〉0．05）；2者均低于移植3枚胚胎者[40．66％（74／182）]，差异有统计学意义（P〈0．01）。（3）年龄〈35岁组的临床妊娠率[48．17％（1658／3442）]高于年龄／〉35岁组[33．05％（315／953）]，差异有统计学意义（P〈0．01）；年龄〈35岁组移植1、2和3枚胚胎者的临床妊娠率分别与年龄／〉35岁组移植相应胚胎数者比较，差异均有统计学意义（P〈0．01）。两组的多胎妊娠率[分别为31．54％（523／1658）和32．06％（101／315）]比较，差异无统计学意义（P〉0．05）。结论IVF—ET患者移植2枚优质胚胎与移植3枚优质胚胎的临床妊娠率相近，但多胎妊娠率降低。年龄对多胎妊娠率无影响。

Objective To observe the influence of patient＇s age, and the number of transferredgood-quality-embryos on multiple gestation rates in in vitro fertilization and embryo transfer（IVF-ET） cycles. Methods In this retrospective study, a total of 4395 patients who transferred fresh embryo between Jan 2004 and Nov 2006 was analyzed. According to the age, the patients were divided into 2 groups ： aged 〈 35 （3442 cycles） or aged ≥35（953 cycles）. We regularly transferred 2 -3 embryos. If the patients had only one embryo, one was transferred. And those patients who had only 2 embryos, even if they were more than 35 years old or it would be the second time for them to transfer, were transferred 2 embryos. The influence of female age and the number of good quality embryos transferred on the multiple gestation rates in IVF-ET cycle was analyzed. Results （ 1 ） The multiple gestation rate of the groups of 1 good quality embryo ,2 good quality embryos, or 3 good quality embryos transferred were 21.08% （35/166）, 31.41% （413/1315） , and 42. 37% （75/177）, respectively in women aged 〈 35, with a significant difference between them. The pregnancy rates of these groups were 29. 64% （166/560） ,51.63% （ 1315/2547 ） , and 52. 84% （ 177/335 ）,respectively; there were no significant differences between 2 good quality embryos transferred group and 3 good quality embryos transferred group. （2） The multiple gestation rates of the groups of 1 good quality embryo,2 good quality embryos, or 3 good quality embryos transferred were 19. 51% （8/41） ,20. 65% （ 19/ 92） ,and g0. 66% （74/182）, respectively, in women aged ≥ 35; there were no significant differences between 1 good quality embryo transferred group and 2 good quality embryos transferred group. The pregnancy rates of these groups were 19. 07% （ 41/215 ）, 33.70% （ 92/273 ）, and 39. 14% （ 182/465 ）, respectively; there were no significant differences between 2 good quality embryos transferred group and 3 good quality embryos transferred group. （3） The pregnancy rate of the patients aged 〈35 [48. 17% （ 1658/ 3442） lwas significantly higher than in women aged≥35133.05% （315/953） ]. Conclusion The transfer of 2 good quality embryos results in similar pregnancy rates and significantly reduced multiple gestation rates when compared to the transfer of 3 good quality embryos in women regardless of their ages.