不同年龄阶段移植1和2枚新鲜或冻融胚胎时的妊娠结局

Impact of age, single or double, fresh or frozen embryo transfer on pregnancy outcome after in vitro fertilization treatment

目的探讨年龄〈38岁及≥38岁患者，在新鲜或冻融胚胎移植周期中移植1和2枚D3胚胎时胚胎种植率、临床妊娠率、多胎妊娠率等的差异。方法回顾性分析浙江大学医学院附属邵逸夫医院生殖中心自2010年1月1日至2012年12月31日所有移植1和2枚D3胚胎共7465个周期资料，其中移植1枚胚胎周期1546个，移植2枚胚胎周期5919个；新鲜胚胎移植周期2447个，冻融胚胎移植周期5018个。结果（1）年龄〈38岁患者移植2枚胚胎与移植1枚胚胎比较：无论新鲜或冻融胚胎移植周期，胚胎着床率差异均无统计学意义，临床妊娠率显著上升（新鲜胚胎移植周期53．3％及35．5％，冻融胚胎移植周期59．8％及38．0％，均P〈0．01）、双胎妊娠率显著上升（新鲜胚胎移植周期28．7％及0．6％，冻融胚胎移植周期：31．1％及3．0％，均P〈0．01）；（2）年龄≥38岁患者移植2枚胚胎与移植1枚胚胎比较：新鲜胚胎移植周期胚胎着床率显著上升（20．3％及9．5％，P〈0．05），冻融胚胎移植周期胚胎着床率差异无统计学意义；临床妊娠率均显著升高（新鲜胚胎移植周期33．2％及9．5％，冻融胚胎移植周期39．0％及21．1％，均P〈0．01）；双胎妊娠率显著升高（新鲜周期19．4％、冻胚周期13．4％），移植1枚胚胎周期无双胎妊娠发生。结论年龄〈38岁患者移植2枚胚胎可显著提高临床妊娠率，但同时多胎妊娠风险显著增加，在充分知情同意情况下可以建议移植1枚胚胎；年龄≥38岁患者建议移植2枚胚胎。

Objective To separately evaluate the embryo implantation rate （IR）, clinical pregnancy rate and multiple pregnancy rate between women 〈 38 years old or I〉 38 years old in fresh or frozen thawed embryo transfer cycles, or in single or double embryo transfer cycles. Methods A total of 7465 single or double embryo transfer cycles between January 2010 and December 2012 at Affiliated Sir Run Run Shaw Hospital, Zhejiang University were analyzed. There were 1546 single embryo transfer cycles and 5919 double embryo transfer cycles; 2447 fresh embryo transfer cycles and 5018 frozen-thawed embryo transfer cycles. Results （ 1 ） Regardless of whether fresh or frozen-thawed embryo was used for transfer, there was no significant difference in embryo implantation rate between single and double embryo transfer groups in women 〈 38 years. The clinical pregnancy rate significantly increased if double embryos were replaced （fresh embryo transfer, 53.3% vs 35.5%; frozen-thawed embryo transfer, 59. 8% vs 38.0%, P 〈0. 01）. Twin pregnancy rate also significantly increased （fresh embryo transfer, 28. 7% vs 0. 6%; frozen-thawed embryo transfer, 31.1% vs 3.0% , P 〈0. 01 ） ; （2） embryo implantation rate in fresh embryo transfer significantly increased in women t〉 38 years old between groups of single or double embryo transfer （20. 3% vs 9. 5% , P 〈0. 05）. No significant difference existed in IR for frozen-thawed embryo transfer. The clinical pregnancy rate significantly increased （ P 〈 0. 01 ） if double embryos were replaced （ fresh embryo transfer, 33.2% vs 9. 5% ; frozen-thawed embryo transfer, 39. 0% vs 21.1% , P 〈 0.01 ）. Twin pregnancy rate was 19.4% in fresh embryo transfers versus 13.4% in frozen-thawed embryo transfers. There was no twin pregnancy in single embryo transfers. Conclusion Compared with single embryo transfer in women 〈 38 years, double embryo transfer can significantly increase the rates of clinical pregnancy nd twin pregnancy. Decision is made after thorough consultations and single embryo transfer is justifiable. Double embryo transfer is indicated for women ≥38 years.