控制移植胚胎数目策略在降低北京市体外受精-胚胎移植多胎妊娠率中的应用及效果分析

Effect of controlled transferred embryo numbers on reducing in vitro fertilization-embryo transfer multiple pregnancy rate in Beijing

目的探讨控制体外受精-胚胎移植(IVF-ET)移植胚胎数目对控制医源性多胎发生率行业管理的实施效果。方法比较北京市人类辅助生殖质量控制和改进中心(辅助生殖质控中心)提出北京市IVF-ET移植胚胎数不多于2枚的策略前、后,北京市各生殖中心移植胚胎数和多胎妊娠率变化。结果北京市生殖中心新鲜和解冻移植周期的平均移植胚胎数目逐年下降,分别由2013年的2.02枚和2.04枚,下降至2015年的1.91枚和1.80枚。2014年、2015年新鲜周期临床妊娠率为45.4%和44.5%,解冻周期临床妊娠率为47.2%和46.2%,均分别显著高于2013年的新鲜周期临床妊娠率(43.2%,P=0.000,P=0.025)、解冻周期临床妊娠率(43.4%,P均=0.000)。2014年新鲜周期的活产率(36.6%)显著高于2013年(35.0%,P=0.004),2015年新鲜周期活产率与2013年比差异无统计学意义(P>0.05)。2014年和2015年解冻周期的活产率(37.4%,36.5%)均显著高于2013年(34.3%,P=0.000,P=0.001)。2015年新鲜周期和解冻周期的多胎妊娠率分别为28.0%和23.5%,显著低于2013年的31.3%和25.7%(P=0.000,P=0.016)。结论辅助生殖质量控制中心提出的建议每移植周期胚胎数目不超过2个,既保证了临床妊娠率和活产率不下降,同时对控制本地区IVF-ET多胎妊娠率效果显著,可为行政决策部门进行行业管理提供参考依据。

Objective To evaluate the effect of management of the number of transferred embryos guided by Beijing Human Assisted Reproductive Technology Center on controlling the multiple pregnancy rate after in vitro fertilization-embryo transfer 0VF-ET） in Beijing. Methods The changes of the number of transferred embryos and the multiple pregnancy rate were compared before and after the control of 2 embryos transfer strategy. Results The data showed that both the number of fresh and frozen-thawed embryos transferred were decreased year by year. Number of fresh embryos transferred was 2.02 in 2013 and 1.91 in 2015, while number of frozen- thawed embryos transferred was 2.02 in 2013 and 1.80 in 2015. Clinical pregnancy rate of fresh transfer cycle was 45.4% and 44.5% in 2014 and 2015, respectively, which was higher than that in 2013 （43.2%, P=-0.000, P=0.025）. Clinical pregnancy rate of frozen-thawed transfer cycle was 47.2% and 46.2% in 2014 and 2015, respectively, which was higher than that in 2013 （43.4%, P=0.000, P=0.000）. Live birth rate of fresh transfer cycle in 2014 （36.6%） was significantly higher than that in 2013 （35.0%, P=0.004）, while there was no significant difference between 2013 and 2015 （P〉0.05）. Live birth rate of frozen-thawed transfer cycle was significantly higer in 2014 and 2015 （37.4%, 36.5%） than in 2013 （34.3%, P=0.000, P=0.001）. The multiple pregnancy rates of fresh and fr0zen-thawed embryo transfer in 2015 were 28.0% and 23.5%, which were significantly lower than those in 2013 （31.3%, 25.7%; P=0.000, P=0.016）, respectively. Conclusion The strategies proposed by Beijing Human Assisted Reproductive Technology Center to control the number of IVF-ET embryos were well implemented. It not only ensures that clinical pregnancy rate and live birth rate do not decline, but also has a significant effect on the control of IVF-ET multiple pregnancy rate, which can provide the reference for the administrative decision- making department for the next step of the industrial management.