国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2021, Vol. 40 ›› Issue (1): 6-10.doi: 10.12280/gjszjk.20200311

• 论著 • 上一篇    下一篇

辅助生殖技术中移植胚胎数目、级别与妊娠结局关系的探讨

苏敏, 游敏, 张红梅, 王丽媛, 土增荣, 田秀珠()   

  1. 030001 太原,山西医科大学第一临床医学院（苏敏）; 山西医科大学第一医院生殖中心（游敏,张红梅,王丽媛,土增荣,田秀珠）
  • 收稿日期:2020-06-02 出版日期:2021-01-15 发布日期:2021-01-21
  • 通讯作者: 田秀珠 E-mail:Tianxiuzhu1963@163.com

Study on the Relationship between the Number and Grade of Embryo Transfer and Pregnancy Outcome in Assisted Reproductive Technology

SU Min, YOU Min, ZHANG Hong-mei, WANG Li-yuan, TU Zeng-rong, TIAN Xiu-zhu()   

  1. The First Clinical Medical College, Shanxi Medical University, Taiyuan 030001, China (SU Min); Department of Reproductive Center, The First Hospital of Shanxi Medical University, Taiyuan 030001, China (YOU Min, ZHANG Hong-mei, WANG Li-yuan, TU Zeng-rong, TIAN Xiu-zhu)
  • Received:2020-06-02 Published:2021-01-15 Online:2021-01-21
  • Contact: TIAN Xiu-zhu E-mail:Tianxiuzhu1963@163.com

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摘要：

目的:探讨辅助生殖技术中新鲜周期移植胚胎数目、级别与妊娠结局的关系。方法:回顾性分析1 261个新鲜移植周期患者的临床资料。按照年龄分层后依据移植胚胎数目分组（<35岁：A组,移植1枚胚胎;B组,移植2枚胚胎;≥35岁：a组,移植1枚胚胎;b组,移植2枚胚胎;c组,移植3枚胚胎）,每组再依据移植Ⅰ级胚胎数分亚组,A组分为A0、A1组（移植Ⅰ级胚胎数为0、1）,同理B组分为B0、B1、B2组。用同样的分组方法将≥35岁患者分别分为a组（a0、a1组）、b组（b0、b1、b2组）、c组（c0、c1、c2组）,比较各组间妊娠结局的差异。结果:①<35岁患者中,A1组的临床妊娠率、种植率显著高于A0组（P<0.05）;B2组的种植率、临床妊娠率、多胎妊娠率和活产率均显著高于B0、B1组（均P<0.05）。同时,B0组的临床妊娠率高于A0组,A1组的种植率高于B1组,多胎妊娠率低于B1组（P<0.05）,组间其余指标差异均无统计学意义（均P>0.05）。②≥35岁患者中,a1组的种植率、临床妊娠率和活产率显著高于a0组（均P<0.05）;b1、b2组的临床妊娠率和活产率均高于b0组,b2组种植率高于b0组（P<0.05）;c2组的种植率、临床妊娠率高于c0、c1组,而多胎妊娠率、活产率仅高于c0组（P<0.05）。同时,c2组的多胎妊娠率显著高于b2组（P<0.05）,组间其余指标差异均无统计学意义（P>0.05）。结论:新鲜移植周期中,应根据患者胚胎数目、级别实行个体化的胚胎移植方案。无论任何年龄,建议移植胚胎数不多于2枚,移植Ⅰ级胚胎数不多于1枚;对于有条件的患者,可行单胚胎移植,既可保证临床妊娠率,又可有效降低多胎妊娠率。

关键词: 胚胎移植, 胚胎数量, 胚胎级别, 妊娠, 多胎, 年龄因素, 妊娠结局

Abstract:

Objective: To explore the relationship between the number and grade of transferred embryos in fresh cycle and the pregnancy outcome in assisted reproductive technology.Methods: The clinical data of 1 261 cases of fresh transfer cycles were analyzed retrospectively. According to the number of transferred embryos after age stratification were grouped. In women of <35 years, the group A is single embryo transfer and the group B double embryos transfer. In women of ≥35 years, the group a is single embryo transfer the group b double embryos transfer, and the group c three embryos transfer. In each group, patients were further divided into subgroups according to the number of grade Ⅰ embryos transferred. The group A was divided into the group A0 and the group A1 (the number of gradeⅠembryos transferred was 0 and 1). Similarly, the group B was divided into group B0, B1 and B2. With the same grouping method, patients aged ≥35 years were divided into subgroups (the group a as group a0 and a1; the group b as group b0, b1 and b2; the group c as group c0, c1 and c2). The differences of pregnancy outcome were compared.Results: ①In patients <35 years, the clinical pregnancy rate and implantation rate of group A1 were significantly higher than those of group A0 (both P<0.05). The implantation rate, clinical pregnancy rate, multiple pregnancy rate and live birth rate of group B2 were significantly higher than those of group B0 and B1 (all P<0.05). Meanwhile, the clinical pregnancy rate of group B0 was higher than that of group A0, the implantation rate of group A1 was higher than that of group B1, and the multiple pregnancy rate of group A1 was lower than that of group B1 (all P<0.05). There was no significant difference in other indexes among the groups (all P>0.05). ②In patients aged ≥35 years, the implantation rate, clinical pregnancy rate and live rate of group a1 were significantly higher than those of group a0 (all P<0.05). The clinical pregnancy rate and live birth rate of group b1 and b2 were higher than those of group b0, the implantation rate of group b2 was higher than that of group b0 (all P<0.05). The implantation rate and clinical pregnancy rate of group c2 were significantly higher than those of group c0 and c1. However, the multiple pregnancy rate and live birth rate of group c2 were higher than those in group c0 (P<0.05). Meanwhile, the multiple pregnancy rate of group c2 was significantly higher than that of group b2 (P<0.05). There was no significant difference in other indexes between the groups (P>0.05).Conclusions: In the fresh embryo transfer cycles, the individualized embryo transfer program should be implemented according to the number and grade of embryos. It is suggested that no more than 2 embryos and no more than 1 embryo of grade Ⅰ should be transferred in patients of any age. The single embryo transfer can not only ensure the clinical pregnancy rate, but also effectively reduce the multiple pregnancy rate for the patients with conditions.

Key words: Embryo transfer, Number of embryo, Embryo grade, Pregnancy, multiple, Age factors, Pregnancy outcome