单胚胎移植临床结局分析

Clinical Outcome Analysis of Single Embryo Transfer

【目的】探讨辅助生殖领域单胚胎移植(SET)的应用前景。【方法】回顾性分析我院生殖中心近两年进行SET的5130例新鲜与冷冻移植周期资料。对新鲜、冷冻周期分别进行比较,并分成选择性和被迫性SET亚组,对比患者的不同胚胎类型、不同年龄段在新鲜与冷冻周期情况下的临床妊娠结局。【结果】在非植入前遗传学检测(PGT)选择性SET周期中,35岁前移植第3天胚胎(D3)和第6天胚胎(D6)的临床妊娠率高达30%,第5天胚胎(D5)的临床妊娠率可高达50%;在PGT周期,小于42岁的患者临床妊娠率可达45%,特别是D5种植率在小于40岁的患者中各年龄段均可接近60%。随着年龄增加,SET妊娠率降低。在非PGT周期,D3胚胎在选择性、被迫性新鲜及冷冻周期各组间的临床妊娠率差异有统计学意义(P<0.001),整体为选择性移植比被迫性移植临床妊娠率高。在D5、D6冷冻移植周期,选择性和被迫性组的临床妊娠率差异无统计学意义(P=0.074和P=0.596);PGT周期中,D5胚胎选择性移植组较被迫性移植组临床妊娠率高,差异有统计学意义(P=0.011)。而D6胚胎选择性与被迫性移植组的临床妊娠率比较差异无统计学意义(P=0.979)。非PGT周期各类型的胚胎移植在不同年龄段的临床妊娠率差异均有统计学意义(P<0.001),总体上被迫性D3和D6移植组的临床妊娠率最低。PGT周期在小于40岁患者的各年龄段中,选择性D5胚胎移植组的临床妊娠率均高于D6组,每组间比较差异均有统计学意义(P<0.001)。【结论】临床上SET的临床妊娠情况良好。为避免由多胎引起的围产期并发症,临床医生及患者可以积极推进并选择SET。

【Objective】To explore the application prospect of single embryo transfer(SET)in assisted reproduction.【Methods】A total of 5 130 cases of fresh and frozen embryo transfer in the Reproductive Center of the First Affiliated Hospital,Sun Yat-sen University in the recent two years were analyzed retrospectively. To analyze the main outcome of clinical pregnancy in different age groups,we classified the SET cycles into 4 groups of fresh or frozen,elective or obliged.【Results】In non-preimplantation genetic testing(PGT )elective SET cycles,the clinical pregnancy rate of the day 3 embryos(D3)and day 6 embryos(D6)in patients under 35 were as high as 35%. The clinical pregnancy rate of day 5 embryos(D5)was 50% approximately. While in PGT cycles, the clinical pregnancy rate of patients less than 42 years old was 45%,especially implantation rate of D5 embryos was close to 60% in all patients under 40. With the increase of age,the pregnancy rate of SET decreased. In non- PGT group,D3 embryos showed significant difference in either elective/obliged or fresh/frozen cycles(P < 0.001 for all). In general,elective SET showed a higher pregnancy rate than obliged cycles. There was no significant difference between the elective and obliged frozen cycles of D5 or D6 embryos regarding clinical pregnancy rate(P = 0.074 and P = 0.596, respectively). Elective D5 embryo transfer group had a higher pregnancy rate than that of the obliged group(P = 0.011). However,there was no significant difference of clinical pregnancy rate between elective and obliged groups of D6 embryos(P = 0.979). In non-PGT cycles,clinical pregnancy rate was significantly different among different age groups of either elective/obliged or fresh/ frozen cycles(P < 0.001). Obliged D3 and D6 embryo transfer groups showed the lowest pregnancy rate ,and in PGT cycles of patients under 40,D5 embryo showed a higher pregnancy rate than that of D6 group as a whole (P < 0.001).【Conclusion】The outcome of SET strategy seemed good in the last 2 years. In order to avoid perinatal complications caused by multiple fetuses,clinicians and patients should actively promote and choose SET.