不同受精方式及移植时间对异位妊娠发生的影响

Association of fertilization strategy and embryo transfer time with the incidence of ectopic pregnancy

目的:探讨不同受精方式及不同胚胎移植时期是否会影响妇女异位妊娠(EP)的发生。方法:选择在本院生殖中心接受常规体外受精-移植(IVF-ET)或卵细胞胞质内单精子注射-移植(ICSI-ET)助孕治疗并成功妊娠患者的3 331个新鲜移植周期和2 706个冻融移植周期。新鲜移植周期中,IVF-ET周期2 546例,ICSI-ET周期785例,卵裂期胚胎移植2 220例,第5天囊胚移植1 111例;冻融移植周期中,IVF-ET周期2 080例,ICSI-ET周期626例,卵裂期胚胎移植741例,第5天或第6天囊胚移植1 965例。根据不同的受精方式及移植时间,比较各组间EP的发生情况。结果:新鲜移植妊娠周期中,2 546例IVF-ET周期EP发生36个周期(1.41%),785例ICSI-ET周期EP发生27个周期(3.44%),两组间的EP发生率比较,差异有统计学意义(P<0.01)。冻融移植妊娠周期中,2 080例IVF-ET周期EP发生21个周期(1.01%),626例ICSI-ET周期EP发生5个周期(0.80%),两组间的EP发生率比较,差异无统计学意义(P>0.05)。IVF-ET和ICSI-ET周期中,新鲜D3移植组(F-D3)、新鲜D5移植组(F-D5)、冻融D3移植组(T-D3)及冻融D5/6移植组(T-D5/6)各占2 220例、1 111例、741例、1 965例,EP发生例数分别为38例、25例、10例、16例,EP发生率分别为1.71%、2.25%、1.35%、0.81%,T-D5/6组EP发生率显著低于其他组(0.81%vs 1.71%,2.25%,1.35%,P<0.05)。结论:不同的受精方式可能会影响EP发生率,冻融周期囊胚移植EP的发生率显著低于新鲜周期胚胎移植和冻融周期卵裂期胚胎移植。

Objective：To investigate the correlation of the fertilization strategy and embryo transfer（ET）time with the incidence of ectopic pregnancy.Methods：We selected 3 331 fresh and 2 706 frozen-thawed ET cycles for the patients undergoing in vitro fertilization（IVF）and intracytoplasmic sperm injection（ICSI）.The fresh transfers included 2 546 IVF-ET and 785 ICSI-ET cycles and 2 220 day-3 embryo and 1 111 day-5 blastocyst transfers,while the frozen-thawed transfers included 2 080 IVF-ET and 626 ICSIET cycles and 741 day-3 embryo and 1 965 day-5 or-6 blastocyst transfers.We compared the incidence rate of ectopic pregnancy associated with different fertilization strategies and ET time.Results：The incidence rate of ectopic pregnancy was 1.41%（36 /2 546）in the IVF-ET cycles and 3.44%（27 /785）in the ICSI-ET cycles of the fresh transfers,significantly lower in the IVF-ET than in the ICSI-ET cycles（P 〈0.01）,and it was 1.01%（21 /2 080）in the IVF-ET cycles and 0.80%（5 /626）in the ICSI-ET cycles of the frozen-thawed transfers,with no remarkable difference between the two groups（P〉 0.05）.The IVF-ET and ICSI-ET cycles included2 220 fresh day-3（F-D3）embryos,1 111 F-D5 blastocysts,741 frozen-thawed day-3（T-D3）embryos,and 1 965 T-D5 /6 blastocysts.The incidence rate of ectopic pregnancy was 1.71%（n = 38）in the F-D3,2.25%（n = 25）in the F-D5,1.35%（n = 10）in the T-D3,and 0.81%（n = 16）in the T-D5 /6 group,respectively,significantly lower in the T-D5 /6 than in the other three groups（P 〈0.05）.Conclusion：The incidence rate of ectopic pregnancy is associated with fertilization strategies,which is significantly lower in frozen-thawed than in fresh embryo transfers.