胚胎移植与囊胚移植的临床结局分析

Analysis of clinical outcomes for embryo transfer and blastocyst transfer

背景:国内关于卵裂期胚胎移植与囊胚移植的临床比较与分析大样本报道较少见。目的:比较第2,3天卵裂期胚胎移植与第5天囊胚移植的临床结局。方法:选择2008-01/2009-12北京大学深圳医院生殖医学科行体外受精/卵胞浆内单精子显微注射共1612周期,比较第2,3天卵裂期胚胎移植与第5天囊胚移植的临床妊娠率、胚胎种植率、流产率、多胎率、出生婴儿性别比例等差异。结果与结论:第2,3,5天移植组分别195,1162,255周期,临床妊娠率分别为33.33%,38.04%,44.71%,种植率分别为21.37%,24.70%,31.96%;第5天移植组临床妊娠率和种植率均高于第2,3天移植组(P<0.05);第2天移植组宫外孕发生率高于第3天移植组(P<0.05)。3组流产、单卵双胎、多胎、早产及出生婴儿性别比例无差异。说明囊胚移植提高了临床妊娠率和种植率的同时,未增加流产、多胎、早产等风险,对男女性别比例的平衡无负面影响。

BACKGROUND： It is less reported in China about the clinical outcome of cleavage-stage embryo transfer and blastocyst transfer. OBJECTIVE：To compare the clinical outcome of the cleavage stage transfer and blastocyst transfer. METHODS：1 612 IVF/ICSI cycles treated in Peking University Shenzhen Hospital between January 2008 and December 2009 were included in the study. It was compared between D2/D3 cleavage stage transfer and D5 blastocyst transfer about clinical pregnancy rate, implantation rate, abortion rate, multiples and sex ratio of neonatal. RESULTS AND CONCLUSION：The cycle number of D2/D3/D5 group was 195, 1162 and 255. The clinical pregnancy rate was 33.33%, 38.04%, 44.71% respectively for three groups. The implantation rate was 21.37%, 24.70%, 31.96%. The clinical pregnancy rate and implantation rate were higher in D5 group than in D2/3 group （P 0.05）. For ectopic pregnancy, the risk estimate was higher in D2 group than in D3 group. No statistically differences existed in regard to abortion, monozygotic twin, multiples, preterm birth and sex ratio of neonatal among three groups. It was demonstrated a higher pregnancy rate and implantation rate after blastocyst transfer than after cleavage stage transfer. At the same time, the risk of abortion, monozygotic twin, multiples, preterm birth had not increased. It had no adverse effect on the sex ratio of neonatal.