辅助生殖技术单卵双胎相关因素分析及含单绒毛膜双胎三胎妊娠减除单绒毛膜双胎之一的临床结局比较

Analysis of related factors of monozygotic twins in assisted reproductive techniques and the clinical outcomes of dichorionic triplet pregnancy which reduced one monochorionic twin

目的探讨辅助生殖技术(ART)治疗后行多胎妊娠减胎术中单卵双胎(MZT)的发生和三胎妊娠行单绒毛膜双胎中一胎减胎术保留双胎者的临床结局。方法回顾性分析ART治疗后行经阴道多胎妊娠减胎术的196例患者的临床资料,分析比较MZT在不同分组中的发生情况,同时比较其中伴单绒毛膜双胎的三胎妊娠减单绒毛膜双胎之一者(A组)与不伴单绒毛膜双胎的三胎妊娠减胎后保留双胎者(B组)的临床结局。结果 (1)196例患者中MZT所占比率为44.39%(87/196)。MZT占比率在体外受精(IVF)组(0.85%)、卵胞质内单精子显微注射(ICSI)组(0.66%)、冻融胚胎移植(FET)组(0.78%)和人工授精(AIH/AID)组(0.16%)间比较差异有统计学意义(P=0.001);在辅助孵化(AH)组(1.48%)和无AH组(0.44%)间比较差异亦有统计学意义(P=0.000)。MZT占比率在高龄(≥35岁)和非高龄患者中(P=0.330)及卵裂期胚胎移植组和囊胚期胚胎移植组组间(P=0.950)比较差异无统计学意义。(2)A组和B组患者的平均年龄、平均孕周、新生儿的平均胎龄、平均胎儿出生体质量、流产率、早期流产率、晚期流产率、早产率、足月产率、活产率、低出生体质量儿发生率、新生儿出生缺陷率和妊娠并发症率比较,差异均无统计学意义(P>0.05)。结论 ART行多胎妊娠减胎术的患者中MZT所占几率很高,为减少MZT的发生,尽量选择单胚胎移植;A组和B组患者临床结局无统计学差异,单绒毛膜双胎中一胎减胎术可能是安全而可行的。

Objective To investigate the incidence of monozygotic twins （MZT） and the clinical outcomes of dichorionic triplet pregnancy which reduced one monochorionic twin after multifetal pregnancy reduction with assisted reproductive techniques （ART）. Methods A retrospective analysis was performed in 196 patients who underwent vaginal multifetal pregnancy reduction after ART. The proportion of MZT in different groups was analyzed, and the clinical outcomes of dichorionic triplet pregnancy which reduced one monochorionic twin （group A） with trichorionic triplet pregnancy which reduced to twins （group B） were compared. Results 1） The proportion of MZT in 196 patients was 44.39% （87/196）. There was a significant difference in the proportion of MZT among the in vitro fertilization （IVF） group, the intracytoplasmic sperm injection （ICSI） group, the frozen-thawed embryo transfer （FET） group and the artificial insemination （AIH / AID） group （P=-0.001）. There was also a significant difference between the assisted hatching （AH） group and the non-AH group （P=-0.000）. There was no significant difference in the proportion of MZT between the elderly （≥35 years） patients and non-elderly patients （P=-0.330） and between the cleavage stage embryo transferred group and the blastocyst stage embryo transferred group （P=0.950）. 2） The patients＇ average age,the mean gestational age, the mean gestational age of newborns and the mean birth weight were similar. There was no significant difference in abortion rate, early abortion rate, late abortion rate, preterm birth rate, term birth rate, live birth rate, low birth weight rate and the incidence of neonatal birth defects and pregnancy complications （P〉0.05）. Conelusion The proportion of MZT was high in ART patients with multifetal pregnancy reduction. It should transform to a single embryo thansfer to reduce MZT incidence. There was no difference in clinical outcomes between group A and group B, multifetal pregnancy reduction of one monochorionic twin in dichorionic triplet pregnancy may be safe and feasible.