行IVF／ICSI各年龄段妇女早期单、双胎妊娠丢失的回顾性研究

Analysis of Early Pregnancy Loss between Single and Twin Pregnant Women with Different Age

目的：分析行IVF／ICSI的各年龄段妊娠妇女早期单、双胎妊娠胚胎丢失的影响因素。方法：回顾性分析行IVF／ICSI治疗，授精后第2日或第3日移植2～3个胚胎后单、双胎妊娠周期中早期妊娠囊丢失情况。结果：共收集到1674个IVF／ICSI周期，孕6周单胚胎着床1077例，双胚胎着床597例。孕12周时单胎和双胎的继续妊娠数分别为901例（83．66％）和548例（91．79％）（P〈0．001）。双胎妊娠中，21例（3．52％）自然减胎成单胎，28例（4．69％）自然流产。单胎和双胎妊娠中，每个着床妊娠囊的丢失率分751为16．34％（176／1077），6．45％（741／1194）（P〈0．001）。妊娠妇女早期妊娠囊丢失率单胎者高于同年龄段双胎妊娠者，26～37岁各年龄段妇女单胎与双胎妊娠丢失率间差异均有统计学意义（P〈0．05），≥38岁妇女双胎妊娠丢失率显著增加。单胎妊娠组Gn每日用量显著高于双胎妊娠组（P〈0．05），而受精率及优质胚胎率单胎妊娠组显著低于双胎妊娠组（P〈0．001），Gn每日用量、受精率及优质胚胎率在妊娠丢失组和继续妊娠组间无统计学差异（P〉0．05）。结论：双胎妊娠早期能获得更好的继续妊娠机会，随年龄增加尤其是≥38岁妇女，妊娠丢失显著上升。胚胎形态学质量好则有助于双胚胎着床，但是对继续妊娠没有直接明显的影响。

Objective： To analyze influencing factors of early pregnancy loss between pregnant women of single and twin gestations with different age. Methods： Analysis of the outcomes of 1 674 pregnancies after double or three embryos transfer on day 2 or 3 after IVF or ICSI treatment was performed retrospectively. Results： Of 1 077 single implantations at 6 gestation weeks, 901 cases （83.66%） were ongoing pregnancies. 0f-597 multiple implantations at 6 gestation weeks, 548 cases （91.79%） were ongoing multiple pregnancies, at 12 gestation weeks, 21 cases （3.52%） were ongoing singleton pregnancies and 28 cases （4.69%） ended in a spontaneous abortion. Loss rate per gestational sac was 16.34% （176/1 077） and 6.45% （241/1 194） （P〈0.001） in singleton and twin gestations groups, respectively. Loss per gestational sac in singleton gestation group was significantly higher than that in twin gestations group with the same age, especially between 26-37 year-old （P〈0.05）. Loss per gestational sac in twin gestations group was significantly increased above 38 years old. The dose of Gn used per day was significantly higher （P〈0.05）, but the fertilization rate and the good-quality embryo rate were lower in singleton gestation group than those in twin gestations group （P〈0.001）. The dose of Gn used per day, the fertilization rate and the good-quality embryo rate had no significant differences between onging pregnancy group and pregnancy loss group （P〈0.05）. Conclusion： The chances of continuation of pregnancy was better in twin pregnancies, but decreased fast with increasing maternal age especially above 38 years old. Although multiple implantations at 6 gestation weeks was predominantly determined by morphological embryo quality, the continuation of pregnancy beyond 6 gestation weeks was independent on morphological embryo quality.