解冻周期序贯移植在反复种植失败患者中的应用

Thawing cycle sequential embryo transfer in patients with repeated implantation failure

目的对比分析解冻周期序贯移植和单纯囊胚移植对反复种植失败患者冻融胚胎移植结局的影响。方法将170例反复种植失败患者分为序贯移植组(进行D3和D5/6胚胎序贯移植)71例和单纯囊胚移植组(为单纯囊胚移植)99例。2组本次均为解冻移植周期,均采用自然周期或激素替代周期的方法准备内膜和超声引导下进行移植手术。对2组胚胎种植率及临床妊娠率等妊娠结局进行对比分析。结果序贯移植组临床妊娠率(60.6%vs.31.3%)和胚胎种植率(34.8%vs.23.8%)均高于单纯囊胚移植组(P<0.05);序贯移植组胚胎移植总数高于单纯囊胚移植组,但囊胚移植个数低于单纯囊胚移植组(P<0.05),2组移植1个以上优质囊胚比例差异无统计学意义。序贯移植组临床妊娠患者中有20例为双胎妊娠(46.5%)和5例三胎妊娠,单纯囊胚移植组分别为5例和1例,2组均无三胎以上妊娠发生。结论对于反复种植失败患者采用序贯移植可作为一种有效的移植手段,该方案避免了患者取消移植周期的风险,并对有些较多移植胚胎数的患者有效。

Objective To compare the outcome of in vitro fertilization(IVF)between sequential embryo transfer andsimple blastocyst transplantation in patients with previous multiple IVF failures.Methods A total of170patients withrepeated implantation failure were divided into sequential transfer group(n=71)and blastocyst transfer only group(n=99).Aretrospective matched case-control analysis was made for the medical files of71patients who underwent sequential transferof D3embryos and blastocysts.The control group included99matched women who underwent embryo transfer on D5/6only.All of the patients in two groups used the same protocols of emdometrium preparation(natural cycle or hormone-replacementcycle)and ultrasound-guided transplantation.The embryo implantation rate and clinical pregnancy rate were compared andanalyzed between two groups.Results Sequential transfer of embryos resulted in a clinical pregnancy rate of60.6%compared with that of31.3%following D5/6embryo transfer,and the implantation rate was34.8%and23.8%respectively(P<0.05).Although the total number of transfered embryos were higher in sequential transfer group than that of blastulatransfer only group,the number of D5/6embryo transfered in sequential transfer group were less than blastula transfer onlygroup(P<0.05).And the number of high quality blastula transfered showed no statistical significant difference between twogroups.There were20cases of twin and5cases of triplet pregnancy in sequential transfer group,which were5cases and1case in blastula transfer only group respectively.While,there was no case of muliple pregnancy beyond triplet in both groupsConclusion Sequential transfer of embryos can be used for women with repeated IVF cycles.The program avoids thepossibility of eliminating the transplant,and which is effective in patients with more transplant embryos.