体外受精胚胎移植累积妊娠率的临床评估

Clinical evaluation on the cumulative pregnancy rates of IVF-ET

目的探讨以每取卵周期累积临床妊娠率作为评估体外受精胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)周期临床结局指标的可行性。方法根据患者的年龄分层,评估2012-2013年在新疆医科大学第一附属医院生殖助孕中心行体外受精/卵胞浆内单精子显微注射技术(IVF/intracytoplasmic sperm injection,ICSI)治疗的患者每取卵周期的累积临床妊娠率。以患者移植术后28 d超声见典型孕囊或无可移植胚胎作为评估标准。结果在873个取卵周期中共获卵11 228个,平均年龄为(32.61±4.35)岁,平均每取卵周期移植胚胎数为(1.86±0.61)个,每移植周期移植胚胎数为(1.80±0.58)个,每取卵周期累积妊娠率为59.6%,双胎妊娠率为23.1%,流产率为11.9%。胚胎移植数相同时,新鲜和解冻周期的妊娠率、种植率差异无统计学意义;移植2个胚胎时,解冻周期移植的双胎率明显高于新鲜周期,差异有统计学意义(P<0.05);移植3个胚胎时,新鲜周期移植的流产率明显高于解冻周期,差异有统计学意义(P<0.05)。年龄>35岁者的累积妊娠率显著下降(P<0.05),流产率显著增加(P<0.05)。结论在IVF/ICSI周期中,减少胚胎移植数不影响累积妊娠率,而多胎妊娠率显著降低;每取卵周期累计妊娠率可以取代每移植周期的临床妊娠率,成为评估IVF-ET治疗结局的新标准。

Objective To evaluate the cumulative clinical pregnancy rates of the in vitro fertilization and em-bryo transfer （IVF-ET）within each oocyte retrieval cycle.Methods The patients,grouped by ages,were given IVF/ICSI treatment in the Assisted Reproductive Center of the First Affiliated Hospital of Xinjiang Medical University in 2012-2013 The cumulative clinical pregnancy rates within each oocyte were evalua-ted.Results In the 873 oocyte retrieval cycles,11 228 ovum were obtained,with the average age of （32.61 ±4.35）,the average number of graftage embryo transfer （1.86±0.61）in each oocyte retrieval cycle,and the average graftage embryonic number （1.80±0.58）in each transfer cycle.The cumulative pregnancy rate of each oocyte retrieval cycle was 59.6%,gemellary pregnancy rate was 23.1%,and abortion rate was 11.9%.When the embryo transfer number was the same,the pregnancy rate and implantation rate in fresh and FET cycle did not show evident difference;the twin rate in FET cycles was significantly higher than that in the fresh cycle when two embryos were transplanted,and the difference was statistically significant （P 〈0.05）;the abortion rate in fresh cycle was significantly higher than that in FET cycle when three em-bryos were transplanted and the difference was statistically significant （P 〈0.05）.Cumulative pregnancy＆amp;nbsp;rates of patients aged 35 plus dropped significantly （P 〈0.05）and abortion rates increased significantly （P〈0.05）.Conclusion In the IVF/ICSI cycle,embryo transfer number reduction had no effects on the cu-mulative pregnancy rate while multiple pregnancy rate significantly decreases.Thus, the cumulative clinical pregnancy rate in each oocyte retrieval cycle can replace clinical pregnancy rate of each transfer cycle and serve as a new standard for IVF-ET treatment outcome evaluation.