选择性卵裂期单胚胎移植的妊娠分娩结局

Pregnancy and obstetric outcomes of elective single versus double cleavage-stage embryo transfer

目的比较选择性卵裂期单个优质胚胎移植与双优质胚胎移植的妊娠分娩结局。方法回顾性分析2014年1月~2015年10月在广州市妇女儿童医疗中心生殖医学中心实施体外受精胚胎移植治疗年轻患者239例,选择单个卵裂期优质胚胎进行移植的年轻患者39例为研究组,同期移植2个优质胚胎的年轻患者200例对照组。分析比较两组间临床妊娠结局及分娩结局。结果两组平均年龄、体质量指数、基础内分泌、不孕年限、HCG日子宫内膜厚度无统计学差异(P>0.05);单胚胎移植组HCG日雌激素水平、获卵数高于双胚胎移植组,总Gn用量低于双胚胎移植组(P<0.05);单胚胎移植组胚胎着床率为56.4%,高于双胚胎移植组的37.8%(P<0.05);两组临床妊娠率和活产率无统计学差异(56.4%vs 66.0%,48.7%vs 51.5%,P>0.05)。单胚胎移植组无1例多胎妊娠,而双胚胎移植组双胎妊娠率为22.7%(P<0.05)。单胚胎移植组分娩孕周、新生儿出生体质量明显高于双胚胎移植组(38.7周vs 37.8周,3.3 kg vs 2.9 kg,P<0.05);早产率在单胚胎组仅为10.5%,低于双胚胎移植组27.2%,但差异无显著性。单胚胎移植组无1例低体质量儿出生,而双胎组低体质量儿比例占22.6%(P<0.05)。结论卵裂期选择性单胚胎移植与双胚胎移植相比,可明显降低双胎率,对活产率无影响,同时可以获得更好的产科结局。

Objective To compare the pregnancy and obstetric outcomes in elective single versus two cleavage-stage embryo transfer. Methods Fresh cleavage-stage embryo transfer cycles between January, 2014 and October, 2015 were reviewed,including 39 single embryo transfer(e SET) cycles and 200 double embryo transfer(DET) cycles. The clinical pregnancy rates,implantation rates, multiple pregnancy rates, live birth rate, and obstetric outcomes(gestational age, preterm delivery rate and mean birth weight) were compared between the two groups. Results The baseline characteristics were comparable between the two groups. The estradiol level on the day of trigger and the oocyte number were significantly higher in e SET group than in DET group(10654.4 pmol/L vs 8284.2 pmol/L and 8.4 vs 7.0, respectively). No significant difference was found in the pregnancy rate(56.4% vs 66.0%) or live birth rate(48.7% vs 51.5%) between the two groups, and their implantation rates differed significantly(56.4% vs 37.8%). No multiple pregnancies occurred in e SET group while the rate of multiple pregnancies was22.7% in DET group. The gestational age and mean birth weight were significantly higher in e SET group(P<0.05), and the preterm delivery rate after DET was nearly three times of that after e SET, although this difference was not statistically significant. Conclusions Elective single embryo transfer can be performed without compromising the live birth rates. Multiple pregnancy rates can be significantly reduced with e SET, which also results in a higher chance of delivering a term singleton live birth compared with DET.