既往自然流产次数与患者第3日胚胎质量的关系研究

Relationship between previous spontaneous abortion and day 3 embryo quality

目的:探讨既往自然流产次数与患者第3日胚胎质量的关系。方法:回顾性分析因单纯输卵管因素或盆腔粘连原因行第1周期体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)治疗的患者资料,排除已知的影响流产和胚胎发育疾病的患者,将患者按流产次数分为4组,分别为既往自然流产次数0次组(n=1 252)、1次组(n=385)、2次组(n=77)和≥3次组(n=36)。结果:第3日的优质胚胎率和受精率各组间比较均有统计学差异(P<0.05);既往自然流产0次、1次、2次组的优质胚胎率随流产次数增加呈下降趋势(P=0.005);但既往自然流产≥3次组的优质胚胎率和受精率较2次自然流产组均有升高趋势,进一步分析患者临床资料显示,既往自然流产≥3次的患者在IVF-ET前进行全面的自然流产原因筛查和治疗的比例显著高于2次自然流产组,差异具有统计学意义(P=0.011)。结论:既往2次自然流产患者的胚胎质量下降;经系统、全面的自然流产原因筛查,并接受相应治疗后再行IVF-ET,自然流产次数≥3次的患者其受精率和优质胚胎率可有所提高。

Objective： To explore whether the previous spontaneous abortion correlated with their day 3 embryo quality or not during the in vitro fertilization and embryo transfer （IVF-ET）. Methods： A retrospective analysis was performed in the first IVF-ET cycle patients due to tubal factor or pelvic adhesions. After excluding the patients with known factor for abortion or embryo development, there were 1 252, 385, 77 and 36 patients who had 0, 1, 2, and 3 or more times previous spontaneous abortions （PSA） respectively. Results： Both the rate of high-quality embryos and fertilization rate were significantly different in any group of previous spontaneous abortion patients （P〈0.05）. Furthermore, downward trend of the high-quality embryo rate was significant in 0, 1, 2 times previous spontaneous abortion patients （P=0.005）. As both the high-quality embryo rate and the fertilization rate in more than 3 times PSA were higher than those in patients with 2 times previous abortion, then the comprehensive screening and treatment was further analyzed on the 2 and 3 or more times previous abortion patients. The rates of patients with comprehensive screening and treatment on abortion causes were significantly higher in patients with 3 or more times abortion than those in patients with 2 times previous abortion. Conclusion： The poor embryo quality was detected in patients with 2 times previous spontaneous abortions. However, the fertilization rate and the high-quality embryo rate were recovered after comprehensive screening and treatment for the causes of recurrent spontaneous abortion before IVF-ET.