新鲜周期胚胎移植位置的确定对妊娠结局的影响

The influence of the location of fresh embryo transfer on pregnancy outcome

目的：探讨经腹部超声引导下体外受精-胚胎移植（IVF-ET）位置对妊娠结局的影响。方法回顾性分析2014年9月至2015年6月于山西医科大学第一医院生殖中心进行IVF-ET的293个周期（部分患者进行2个或2个以上的周期）资料，根据胚胎距宫底距离的不同分为〈1.0 cm组、1.1～1.5 cm组、1.6～2.0 cm组、〉2.0 cm组，同时根据胚胎距宫底的距离占宫腔深度的比例不同分为〈1/6组、1/6～〈1/3组、1/3～〈1/2组、≥1/2组，分别分析各组间妊娠结局有无差异。结果293个新鲜周期中，〈1.0 cm、1.1～1.5 cm、1.6～2.0 cm、〉2.0 cm 4组间各项观察指标差异均无统计学意义（均P〉0.05）。而〈1/6、1/6～〈1/3、1/3～〈1/2、≥1/24组进行比较时，临床妊娠率（28.26%、48.96%、57.52%、28.95%）、种植率（19.39%、31.82%、38.96%、18.75%）差异有统计学意义（P〈0.05），而流产率（7.69%、12.76%、16.92%、18.18%）、异位妊娠率（10.87%、6.25%、4.42%、2.63%）等差异无统计学意义（P〉0.05），但随着比例的增加流产率呈增加趋势，异位妊娠率呈降低趋势。结论胚胎移植过程中胚胎距宫底距离的不同对助孕结局无影响，而胚胎距宫底的距离占宫腔深度比例的不同则会影响妊娠结局。

Objective To explore the effects of in vitro fertilization and embryo transfer（IVF-ET） position after abdominal ultrasound guided on the pregnancy outcome. Methods Retrospective analysis of 293 IVF-ET cycles in our center from September 2014 to July 2015.According to the difference of the distance from the embryo to the bottom of the uterus, transfer cycles are divided into four groups：〈1.0 cm、1.1~1.5 cm、1.6~2.0 cm、〉2.0 cm,meanwhile according to the ratio of the distance from the embryo to the bottom of the uterus and the depth of the uterine cavity, transfer cycles are also divided into four groups：〈1/6、1/6~〈1/3、1/3~〈1/2、≥1/2, respectively analysis if there were significant differences in pregnancy outcome among the groups. Results There was no significant differences in the observed indexes between the four groups〈1.0 cm、1.1~1.5 cm、1.6~2.0 cm、〉2.0 cm in the 293 fresh cycles （P〉0.05）. While the〈1/6、1/6~〈1/3、1/3~〈1/2、≥1/2 four groups were compared,the clinical pregnancy rate （28.26%,48.96%, 57.52%,28.95%） and planting rate（19.39%,31.82%,38.96%,18.75%） were significantly different （P〈0.05）,however, there was no significant difference in the rate of abortion（7.69%、12.76%、16.92%、18.18%）,ectopic pregnancy （10.87%、6.25%、4.42%、2.63%） and so on （P〉0.05）,but with the increase of the proportion,the abortion rate was increasing, the rate of ectopic pregnancy was decreased. Conclusions In the process of embryo transfer, the difference of the distance from the embryo to the bottom of the uterus has no effect on the outcome of the pregnancy, and the difference of the ratio of the distance from the embryo to the bottom of the uterus and the depth of the uterine cavity influence pregnancy outcome.