新鲜周期选择性单囊胚与双囊胚移植临床结局的比较

Comparison of clinical outcomes between selective single blastocyst transfer and double blastocysts transfer in fresh embryo transfer cycles

目的比较新鲜周期IVF/ICSI-ET卵巢储备功能正常患者选择性单囊胚移植(eSBT)与双囊胚移植(DBT)的妊娠结局,探讨eSBT的可行性。方法回顾性分析2014年1月至2015年12月在厦门大学附属第一医院生殖中心行辅助生殖助孕新鲜周期囊胚移植的210例年龄<40岁、卵巢功能正常的患者,根据移植囊胚个数不同分为两组:eSBT组,仅移植1枚优质囊胚,共127例;DBT组,移植2个囊胚(其中至少1个优质囊胚),共83例。比较两组患者的临床妊娠结局及新生儿结局情况。结果两组患者的一般情况、促排卵情况、中重度卵巢过度刺激综合征(OHSS)发生率、胚胎形成情况、临床妊娠率、流产率、宫外孕率、活产率、单卵双胎率及出生婴儿畸形率比较均无显著性差异(P>0.05);eSBT组的种植率显著高于DBT组(73.23%vs.61.45%,P<0.05);eSBT组的多胎率(1.08%vs.49.21%)、晚期流产率(0vs.7.94%)、早产率(3.75%vs.20.37%)、低体重儿出生率(6.17%vs.30.38%)均显著低于DBT组(P<0.05);eSBT组新生儿的平均出生体重显著高于DBT组[(3 160.06±441.94)g vs.(2 735.39±555.08)g,P<0.05]。结论对于年龄<40岁、卵巢功能正常且至少有1枚优质囊胚行新鲜周期移植的患者,可优先考虑eSBT。

Objective： To compare the clinical outcomes of selective single blastocyst transfer（eSBT）with double blastocysts transfer（DBT）in fresh embryo transfer cycles among infertile women with normal ovarian reserve.Methods： A retrospective study including 210 women with normal ovarian reserve undergone fresh embryo transfer cycles,who were transferred at least one blastocyst in good quality,was conducted in our center from January 2014 to December 2015.The patients were categorized into two groups according to the number of blastocyst transferred as follows：eSBT group（n=127）and DBT group（n=83）.The outcomes of pregnancy and newborn were compared between the two groups.Results： There were no significant differences in ovulation status,incidence of moderate or severe OHSS,embryo formation,clinical pregnancy rate,abortion rate,ectopic pregnancy rate,live birth rate,monozygotic twin rate and infant malformation rate between the two groups（P0.05）.The multiple birth rate（1.08%vs.49.21%）,the late abortion rate（0%vs.7.94%）,preterm birth rate（3.75%vs.20.37%）,the rate of low birth-weight infants（6.17%vs.30.38%）in eSBT group were significantly lower than those of DBT group（P0.05）.However,the implanting rate（73.23% vs.61.45%）and the average neonatalweight[（3 160.06±441.94）g vs.（2 735.39±555.08）g]in eSBT group were significantly higher than those of DBT group（P0.05）.Conclusions： For patients under 40 years with normal ovarian reserve who had at least one goodquality blastocyst in fresh embryo transfer cycles,the selective single good-quality blastocyst transfer should be given priority to consideration.