不同移植方案在不同获卵数患者中的临床结局分析

Clinical outcomes of different transferring methods in patients who received different numbers of oocytes

目的比较不同获卵数患者2枚第3天（D3）胚胎移植和单囊胚移植的临床结局,为临床移植策略的选择提供数据支持。方法回顾性分析2014年1月至2014年12月在郑州大学第三附属医院生殖医学科行体外受精/卵胞浆内单精子显微注射（IVF/ICSI）治疗的患者,根据获卵个数分为3组,A组获卵个数为5~9枚卵子,B组为10~14枚卵子,C组为≥15枚卵子。每组患者均有4种不同的移植方式,移植2枚D3胚胎（a）、移植1枚囊胚（b）、复苏移植2枚冷冻D3胚胎（c）和复苏移植1枚冷冻囊胚（d）;比较3组患者卵子的2PN受精率、可移植胚胎率及优质胚胎率;比较各组患者4种移植方式的胚胎种植率、生化妊娠率、临床妊娠率、多胎率和流产率等差异。结果 1A组、B组和C组分别有667、573、479个移植周期,其中A组患者IVF的2PN受精率和可移植胚胎率明显高于B组和C组（P=0.003/P〈0.001）;2A组患者4种移植方式的生化妊娠率、临床妊娠率和流产率差异均无统计学意义（P〉0.05）,但c的种植率明显低于a和d（P=0.027/0.020）;B组患者中d的种植率明显高于a和c（P=0.005/0.001）;C组患者中d的生化妊娠率和临床妊娠率均明显高于a（P=0.048/0.027）和c（P=0.003/0.001）,且囊胚移植的种植率均明显高于D3胚胎（P〈0.05）;33组患者单囊胚移植多胎率较胚胎移植明显降低（P〈0.05）。结论对卵巢高反应人群（获卵数≥15枚）,单囊胚移植在保证高种植率和妊娠率的同时,明显降低了多胎率;而获卵数为5~9枚和10~14枚的患者,D3胚胎移植的临床妊娠率和单囊胚移植相似,但多胎率明显增高;D3胚胎培养囊胚后择期移植具有较高的临床妊娠率,对于获卵数≥10枚患者是最佳的移植方案。

Objective To compare the clinical outcomes of two D3 embryo and single blastocyst transfer in patients retrieving different oocytes,so as to provide data support for selecting a clinical transfer strategy.Methods We made a retrospective analysis of patients who underwent in vitro fertilization/intracytoplasmic sperm injection（IVF/ICSI）between January and December 2014 in the Reproductive Medicine Center,the Third Affiliated Hospital of Zhengzhou University.The patients were divided into three groups according to the number of oocytes received：Group A（5-9 oocytes）,Group B（10-14 oocytes）and Group C（≥15 oocytes）.Patients in each group all received four different transfer methods as follows：transfer of two fresh D3 embryos（a）,transfer of one fresh blastocyst（b）,transfer of two D3 frozen embryos（c）,and transfer of one frozen blastocyst（d）.We compared the 2PN fertilization rate of oocytes,rate of available embryos and rate of good embryos among the three groups.We also compared the embryo implantation rate,biochemical pregnancy rate,clinical pregnancy rate,multiplets rate and abortion rate among the four transfer methods in each group.Results 1 There were 667,573,and 479 transfer cycles in Group A,Group B and Group C,respectively.The 2PN fertilization rate of IVF and available embryos rate was significantly higher in Group A than in Group B and Group C（P=0.003/P〈0.001）.2 Therewas no significant difference in biochemical pregnancy rate,clinical pregnancy rate or abortion rate with the four transfer methods in Group A（P〉0.05）,but the implantation rate of c was significantly lower than that of a and d（P=0.027/0.020）,d had a higher implantation rate than aand c in Group B（P=0.005/0.001）.In Group C,the biochemical pregnancy rate and clinical pregnancy rate of d were significantly higher than those of a（P=0.048/0.027）and c（P=0.003/0.001）.Patients in Group C also had a higher implantation rate than D3 embryos（P〈0.05）.3 The multiple pregnancy rate of single blastocyst transfer decreased compared with D3 embryos transfer in the three groups（P〈0.05）.Conclusion Single blastocyst transfer has both higher implantation rate and lower multiple pregnancy rate in high response patients（15 or more oocytes received）.For patients who received5-9 and10-14 oocytes,D3 embryos have a similar clinical pregnancy rate with that of single blastocyst but a higher multiple pregnancy rate.Single vitrified-warmed blastocyst transfer has a higher clinical pregnancy rate.It is the best transfer method for patients who received more than 10 oocytes.