最优胚胎行单胚胎移植的临床结局分析

Analysis of pregnant outcome with top-quality embryo for single-embryo transfer

目的探讨最优胚胎行单胚胎移植的妊娠结局及可行性。方法对珠海市妇幼保健院生殖中心2010年1月至2012年1月接受体外受精-胚胎移植(IVF-ET)治疗的210个新鲜周期回顾性分析。其中仅获单枚胚胎且为最优胚胎(即本中心采用评分系统中的8A级胚胎)进行胚胎移植的30个周期(A组),2枚最优胚胎行胚胎移植的90个周期(B组),2枚胚胎但仅1枚最优胚胎行胚胎移植的90个周期(C组)。分析和比较A组、B组、C组在年龄、不育年限、促性腺激素(Gn)剂量、人绒毛膜促性腺激素(HCG)日血清雌激素(E_2)水平、孕激素(P)水平、HCG日内膜厚度、获卵数、优质胚胎数、种植率、临床妊娠率、流产率、双胎妊娠率的差异。结果 A组患者的年龄、Gn剂量显著高于B组、C组(P均<0.05),而HCG日E_2水平、P水平、获卵数、优质胚胎数显著低于B组、C组(P均<0.05)。A组患者的不育年限、HCG日内膜厚度、种植率,与B组、C组相比,差异无统计学意义(P均>0.05)。A组患者的双胎妊娠率6.3%,明显低于B组、C组,差异有统计学意义(P均<0.05)。A组患者的临床妊娠率53.3%,显著低于B组,差异有统计学意义(P<0.05),但与C组相比,差异无统计学意义(P>0.05)。A组患者的流产率4.9%,与B组、C组相比,差异无统计学意义(P均>0.05)。结论对于仅获1枚最优胚胎的患者,最优胚胎行单胚胎移植可以达到较高的临床妊娠率,同时明显降低双胎妊娠率。但对于有2枚或以上最优胚胎的患者,最优胚胎行单胚胎移植须慎重。

Objective. To investigate the pregnant outcome with top-quality embryo for single-embryo transfer. Methods. Two hundred and ten fresh cycles from infertile patients who underwent in vitro fertilization-embryo transfer（IVF-ET）in Zhuhai Maternal and Children＇s Hospital and Health Institute between January 2010 and January 2012 were retrospectively analyzed. The patients were divided into group A（single-embryo transfer with top-quality embryo,n= 30）,group B（double embryo transfer with two top-quality embryos,n=90）and group C（double embryo transfer with only one top-quality embryo,n =90）. The pregnancy outcomes were compared and analyzed among the three groups. Results. The average age and total gonadotropin（Gn）dose in group A was higher than those in group B or group C, but the serum estradiol（E2 ）and progesterone（P）levels on HCG day, number of retrieved oocytes and excellent blastomere embryos in group A were significantly lower than those of group B or group C（P〈0. 05）. No statistically significant difference was found in infertility time, endometrial thickness on HCG day, implantation rate among group A, group B and group C（P〉0. 05）. The twin pregnancy rate in group A was 6. 3%, which was significantly lower than that in group B or group C （P〈0.05）. The clinical pregnancy rate in group A was 53.3%,which was lower than that in group B （P〈0.05） ,but no statistically significant difference was found between group A and group C（P〉0.05）. The abortion rate in group A was 4.9%, and no statistically significant difference was found in abortion rate among group A,group B and group C（P〉0.05）. Conclusions： For the patients with only one top-quality embryo, selecting top-quality embryo for single-embryo transfer not only can achieve higher pregnancy rate,but also significantly reduce the risk of twin pregnancy. For the patients with two or more than top-quality embryos, it should carefully select topquality embryo for single-embryo transfer.