体外受精-胚胎移植技术中高龄妇女的移植策略的选择

Suitable embryo transfer strategy for elder women in IVF-ET

目的了解影响体外受精-胚胎移植(IVF-ET)结局的年龄界限值及探讨高龄妇女的移植策略。方法回顾性的分析本中心2008年1月至2010年10月行IVF-ET治疗,常规长方案患者的临床妊娠率及早期流产率,找出高龄患者的年龄分界点;并根据移植时间的不同将高龄患者分为D2、D3、D5新鲜周期移植组和D5复苏周期移植组,比较各组的胚胎耗损率及临床妊娠率、早期流产率。结果 37岁后患者的临床妊娠率急剧下降,早期流产率明显升高。≥37岁的患者,D2、D3、D5新鲜周期移植及D5复苏移植的胚胎耗损率分别为29.9%、55.2%、60.4%和61.6%;临床妊娠率分别为10.7%、26.8%、27.7%和45.9%,早期流产率分别为50.0%、24.4%、20.0%和22.2%。结论 37岁是本中心高龄妇女的年龄分界点;对高龄妇女行D5冻胚复苏移植,可以获得更好的临床结局。

Objective： To investigate the embryo transfer strategy for elder women in IVF-ET. Methods： The data of the patients in IVF-ET from 2008 to 2010 in our IVF center were retrospective analyzed to find the cut off point of age for elder women with IVF-ET. According to the transfer embryos day after oocytes picked up, the elder patients were divided into four groups：I）2,1）3,I）5 fresh embryos transfer and D5 frozen-thawed blastocyst transfer groups. The clinical pregnancy rate, the early miscarriage rat and embryo waste rate were compared among the groups, Results： The pregnancy rate was decreased while miscarriage rate was increased significantly in women of 37 years old. In D2, D3, D5 fresh embryos transfer groups and D5 frozen-thawed blastocyst transfer group, the embryo waste rate was 29.85 %, 55.24 %, 60.43 % and 61.56 %, the pregnancy rate 10.72 %, 26.78 %, 27.27 and 45.92% ,and the early miscarriage rate 50.00% ,24.44% ,20% and 22.22% respectively. Conclusions ： The cut off point of age for elder women with IVF-ET was 37 years old in our IVF Center. The frozen-thawed blastocyst transfer may achieve better clinical result in women of ≥37 years old.