非选择性单胚胎移植的临床结局

Analysis of Clinical Result of Non-selective Single Embryo Transfer

【目的】探讨非选择性单胚胎移植(non-eSET)的临床妊娠结局及单胚胎移植(SET)的可行性。【方法】统计本中心2010年1月至2012年8月间体外受精-胚胎移植治疗中non-eSET第3天(D3)胚胎的临床结局,回顾分析治疗方案、胚胎质量、患者年龄以及治疗周期数对non-eSET的影响。【结果】单精子胞浆内注射(ICSI)周期组2PN受精率(75.7%vs 53.6%,P<0.05)显著高于常规体外受精(IVF)组,但是临床妊娠率(20.9%vs 21.7%,P>0.05)和种植率(20.9%vs 22.2%,P>0.05)没有统计学意义;Ⅰ级胚胎组临床妊娠率和种植率显著高于其他各组(P<0.05);各年龄组间的优质胚胎率没有统计学意义,但是<35组临床妊娠率(30.8%vs 13.9%,P<0.05)和种植率(31.5%vs 13.9%,P<0.05)显著高于≥35组;首次治疗周期组临床妊娠率(23.6%vs 18.9%,P>0.05)和种植率(23.6%vs 19.7%,P<0.05)与非首次治疗组没有统计学意义;微刺激方案组所用垂体促性腺激素量显著低于长方案和短方案组,但是临床妊娠率和种植率较其他各组最高。【结论】胚胎质量是行non-eSET的重要参考因素,微刺激方案能够获得较好的non-eSET临床结局。

[Objective] To analyze the clinical outcomes of non-elective single embryo transfer （non-eSET） and discuss the feasibility of elective single embryo transfer （SET）. [Methods] A retrospective analysis of clinical outcomes was performed on in vitro fertility-embryo transfer （IVF-ET） cycles from January 2010 to August 2012. The embryos were transferred on day 3 （D3）. The effect of different stimulation protocols, embryo quality, maternal age and the number of treatment cycles was studied. [ Results ] The rates of 2PN in the intracytoplasmic sperm injection （ICSI） group were significantly higher than that in the IVF group （75.7% vs 53.6%, P 〈 0.05）. But the clinical pregnancy （PR） （20.9% vs 21.7%, P 〉 0.05） and implantation （IR） （20.9% vs 22.2%, P 〉 0.05） rates were similar. The rates of PR and IR of grade Ⅰ embryo group were similar with grade Ⅱ-Ⅰembryo group （39.5% vs 26.3%, P 〉 0.05 ; 41.9% vs 26.3% ,P 〉 0.05）, but was significantly high than the other two groups. The rates of grade I embryo was not significantly different between the maternal age groups. But the difference of the PR （30.4% vs 14.0%, P 〈 0.05） and IR （31.5% vs 14.0%, P 〈 0.05） were significant between young group （〈 35） and old group （ ≥ 35）. The PR （21.4% vs 22.0%, P 〉 0.05） and IR （20.5% vs 23.2%,P 〈 0.05） were similar between the groups of first cycle and more than 1 cycles. The use of gonadotrophin （Gn） in mild stimulation protocol group was lower than that in the long protocol and short protocol groups. But the clinical pregnancy and the implantation rates were higher than the long protocol and significantly higher than the short protocol. [ Conclusion ] Embryo quality was the main factor affecting the clinical outcomes of non-SET. Mild stimulation protocol was able to achieve good clinical outcomes in the non-eSET.