新鲜周期选择性移植单个囊胚对降低多胎妊娠风险的作用

Role of Elective Single Blastocyst Transfer on Reducing Multiple Pregnances in Fresh Embryo Transfer Cycles

目的:探讨新鲜周期选择性移植单个囊胚(elective single blastocyst transfer,eSBT)对降低多胎妊娠风险的作用。方法:回顾性分析新鲜囊胚移植患者的病历资料,其中可供移植的囊胚数≥2个的患者中,选择性单个囊胚移植周期159个(eSBT组),双囊胚移植周期118个(double blastocysttransfer,DBT组),分析比较eSBT组与DBT组患者的一般情况、超促排卵情况、胚胎发育情况和妊娠结局。结果:①采用序贯囊胚培养法,共培养优质胚胎1 040枚,形成囊胚781枚,囊胚形成率75.09%。②患者一般情况、超促排卵和胚胎发育情况组间均无统计学差异(P>0.05),eSBT组与DBT组临床妊娠率(52.83%vs 57.63%)、流产率(4.76%vs 10.29%)未见明显差异(P>0.05),eSBT组种植率显著高于DBT组(54.09%vs 37.71%,P<0.01),多胎率显著低于DBT组(2.38%vs 30.88%,P<0.01)。③按年龄<30岁、30～34岁、35～38岁分段后,eSBT组各年龄段间临床妊娠率均无明显降低(P>0.05),多胎率均显著降低(P<0.01)。结论:新鲜囊胚移植患者选择性单个囊胚移植能在保证较高临床妊娠率的同时,有效降低多胎妊娠的风险。

Objective: To analyze the role of elective single blastocyst transfer(eSBT) on reducing the risk of multiple pregnances in fresh blastocyst transfer cycles.Methods: A retrospective analysis was performed on 277 fresh blastocyst transfer cycles.Among patients who had at least two blastocysts,159 cycles were follwed elective single blastocyst transfer(eSBT group) and 118 cycles were performed double blastocysts transfer(DBT group).The clinical characteristics and outcomes including implantation rates,pregnancy rates,abortion rates and multiple pregnancy rates were observed.Results: 1) Using sequential blastocyst culture,a total of 1 040 high-quality embryos were cultured and 781 blastocysts formed,so blastocyst formation rate was 75.09%.2) The clinical characteristics of two groups had no statistical difference(P>0.05),the clinical pregnancy rates and the abortion rates had no significant difference between the groups of eSBT and DBT(52.83% vs 57.63%,4.76% vs 10.29%,P>0.05,respectively).While signanficantly higher implantation rate was observed in eSBT group(54.09%) which had lower multiple pregnances rate(32.38%) than those in DBT group(37.71%,30.88%,respectively)(all P<0.01).3) The clinical pregnancy rates and the abortion rates had no significant difference between the groups of eSBT and DBT belonging to <30 years,30-34 years and 35-38 years old subgroups.But multiple pregnancy rate was significantly reduced in eSBT group.Conclution: Patients undergoing elective single blastocyst transfer could maintain high pregnancy rates and reduce the risk of multiple pregnancies.