早卵泡期超长方案鲜胚移植策略及临床妊娠结局分析

The strategy of fresh embryo transfer in the early follicular phase prolonged protocol and analysis of clinical pregnancy outcome and safety

目的探讨在早卵泡期超长方案鲜胚移植中,选择性单胚胎移植与双胚胎移植对临床结局及母婴并发症的影响。方法回顾性分析2015年1月-2016年6月在江西省妇幼保健院生殖中心使用早卵泡期超长方案降调节患者,根据移植胚胎情况分为选择性单卵裂期胚胎移植组(SET组240例)、选择性单囊胚移植组(SBT组473例)、双卵裂期胚胎移植组(DET组3942例),分析组间临床特征、超促排卵情况、妊娠率、着床率、中重度OHSS发生率、多胎妊娠率、剖宫产率、流产率、母婴并发症发生情况等。结果⑴3组间临床基线特征及促排卵临床特征(HCG日内膜厚度、孕酮水平、E2水平、Gn天数、Gn总量、获卵数)基本一致。3组间男女出生性别比、宫外孕率、中重度OHSS发生率、第二个新生儿出生体重方面无统计学差异(P>0.05)。⑵3组在种植率、临床妊娠率、抱婴率方面,组间两两比较均有统计学差异(P<0.05)。其中SBT组种植率最高,而DET组临床妊娠率及抱婴率最高,差异有统计学意义(P<0.05)。SET组早期流产率显著高于SBT组及DET组。SBT组晚期流产率显著低于SET组、DET组。DET组多胎妊娠率、剖宫产率、早产率显著高于SET组及SBT组。DET组产妇孕周、第一个新生儿出生体重、极低/低体重儿率显著低于SET组及SBT组,DET组孕期并发症发生率显著高于SET组,以上差异均有统计学意义(P<0.05)。结论选择性单囊胚移植在保持较高的妊娠率的基础上,显著的降低了患者的多胎率和孕期并发症发生率,为孕期母婴安全提供了良好的保障,适宜有针对性地进行推广应用。

Objective To investigate the effect of selective single embryo transfer and double embryo transfer on clinical outcome and maternal-fetal complications in fresh embryo transfer in the early follicular phase prolonged protocol. Methods In the retrospective study,records of patients undergoing the early follicular phase prolonged protocol treatment from January 2015 to June 2016 in Jiangxi Province Maternal and Child Health Hospital were reviewed. It was divided into three groups according to the strategy of embryo transfer,selective single cleavage stage embryo transplantation group（SET group,240 cases）,selective single blastocyst transplantation group（SBT group,473 cases） and double cleavage stage embryo transplantation group（DET group,3942 cases）. Data was collected from clinical records,including demographic and clinical characteristics,COH and IVF/ICSI results such as basal hormone levels,days of Gn administration,total Gn doses,serum E2,progesterone levels at HCG day,number of oocytes retrieved,endometrial thickness,clinical pregnancy rate,implantation rate,miscarriage rate,and incidence of moderate to severe OHSS,multiple pregnancy rate,cesarean section rate and maternal complications. The baseline characteristics and clinical outcomes were compared between the three groups. Results ⑴The clinical baseline characteristics among the three groups were basically the same. There were no significant differences in the thickness of endometrium,serum progesterone level and E2 level on HCG administration day,days of Gn administration,total Gn doses,number of oocytes retrieved,sex ratio at birth,the incidence of ectopic pregnancy,the incidence of moderate and severe OHSS,the birth weight of second neonates among the three groups（P 0.05）. ⑵Three groups had statistically significant differences in implantation rate,clinical pregnancy rate and take baby home rate（P 0.05）. Among them,group SBT had the highest implantation rate,while the clinical pregnancy rate and take baby home rate were the highest in group DET（P〈0.05）. The early miscarriage rate in SET group was significantly higher than that in group SBT and group DET. The late abortion rate in group SBT was significantly lower than that in group SET and group DET. The multiple pregnancy rate,cesarean section rate and premature delivery rate in group DET were significantly higher than those in group SET and group SBT. The gestational weeks,birth weight of first neonates and the extremely low/low weight infants rate in group DET were significantly lower than that in group SBT and group SET（P〈0.05）. And the incidence of pregnancy complications in group DET was higher than that in group SET（P〈0.05）. Conclusion Selective single blastocyst transplantation can maintain a high clinical pregnancy rate,significantly reduce the incidence of multiple pregnancy and complications during pregnancy,and provide a good guarantee for maternal and child safety during pregnancy,and is suitable for targeted application.