单囊胚移植在全胚冷冻患者中的临床应用

doi:10.7504/fk2015030118

摘要/Abstract

摘要：

目的探讨全胚冷冻后冻融胚胎移植（FET）周期第3天(D3)卵裂期胚胎，第5、6天双囊胚及单囊胚移植的临床效果分析。方法回顾性分析2010年1月至2012年12月在河南省人民医院生殖医学研究所行体外受精-胚胎移植（IVF-ET）的不孕患者，以全胚玻璃化冷冻FET周期的患者为研究对象，根据患者的意愿分为D3胚胎移植组（A组，n=456）；双囊胚移植组（B组，n=106）；单囊胚移植组（C组，n=402）。比较3组之间基本资料、IVF治疗的妊娠结局。结果与A组比较，B、C两组患者平均冷冻胚胎数、平均移植胚胎数少，移植周期率低，而种植率高，差异有统计学意义（P＜0.05）；C组平均移植胚胎数亦少于B组，而B组临床妊娠率、最初周期妊娠率高于A、C两组，C组多胎率低于A、B两组，差异均有统计学意义（P＜0.05）；C组早期流产率显著性低于A组，差异有统计学意义（P＜0.05）。结论对于全胚冷冻患者，当D3可利用胚胎个数≥4时，囊胚培养后玻璃化冷冻，择期FET周期选择性单囊胚移植是目前最佳的冷冻策略和最有益的临床处理方案。

关键词: 体外受精-胚胎移植, 妊娠率, 囊胚

Abstract:

Abstract： Objective To compare the clinical outcomes of the cleavage stage embryos, double blastocyst and single blastocyst transfer in frozen embyro tranfer(FET) cycles after all embryos frozen. Methods Retrospective analysis was done in infertility patients who underwent in-vitro fertilization & embryo transfer (IVF-ET) in the Reproductive Medicine Center of Henan Provincial People’s Hospital during Jan.2010 and Dec.2012. According to the wishes of patients, the patients were divided into cleavage-stage embryo transfer (group A, n=456), double blastocyst transfer(group B, n=106)and single blastocyst transfer(group C, n=402).Results The number of average frozen embryo and the number of average embryo transfer were less in group B and C compared with group A,while the implantation rate was higher(P< 0.05). The average number of embryo transfer in group C was also less than that in group B(P<0.05). The clinical pregnancy rate and the pregnancy rate of initiated cycles in gruop B were significantly higher than those in group A and C, and the multiple pregnancy rate in group C was significantly lower than those in group A and B (P<0.05); the early abortion rate in group C was significantly lower than that in group A(P<0.05). Conclusion For patients who need to freeze all embryos, cryopreservion of all available blastocysts through vitrification and single blastocyst transfer may be the most cost-effective and achievable strategy.

Key words: in vitro fertility and embryo thansfer, pregnancy rate, blastocyst

中图分类号:

R321-33

何巧花，王璐，梁琳琳，张合龙，张翠莲. 单囊胚移植在全胚冷冻患者中的临床应用[J]. 中国实用妇科与产科杂志, DOI: 10.7504/fk2015030118.

HE Qiao-hua, WANG Lu, LIANG Lin-lin, ZHANG He-long, ZHANG Cui-lian.. Analysis of the clinical effect of single blastocyst transfer for patients with all the embryos vitrified.[J]. Acta Metallurgica Sinica, DOI: 10.7504/fk2015030118.

参考文献

［1］   Oque M, Lattes K, Serra S, et al. Fresh embryo transfer versus frozen embryo transfer in in vitro fertilization cycles: a systematic review and meta-analysis［J］. Fertil Steril,2013,99(1):156-62.

［2］   Zhu D, Zhang J, Cao S,et al. Vitrified-warmed blastocyst transfer cycles yield higher pregnancy and implantation rates compared with fresh blastocyst transfer cycles--time for a new embryo transfer strategy?［J］. Fertil Steril,2011,95(5):1691-1695.

［3］   Ae RH, Chan WP, Hyoung-Song L, et al.Blastocyst transfer in frozen-thawed cycles［J］. Clin Exp Reprod Med,2012,39(3):114-117.

［4］    Papanikolaou EG, Kolibianakis EM, Tournaye H, et al. Live birth rates after transfer of equal number of blastocysts or cleavage-stage embryos in IVF. A systematic review and meta-analysis［J］. Hum Reprod,2008,23(1):91-99.

［5］    Zander-Fox DL, Tremellen K, Lane M. Single blastocyst embryo transfer maintains comparable pregnancy rates to double cleavage-stage embryo transfer but results in healthier pregnancy outcomes［J］. Aust N Z J Obstet Gynaecol，2011,51(5):406-410.

［6］ Mullin CM, Fino ME, Talebian S, et al. Comparison of pregnancy outcomes in elective single blastocyst transfer versus double blastocyst transfer stratified by age[J]. Fertil steril, 2010, 93(6): 1837-1843.

［7］   Kawachiya S, Bodri D, Shimada N，et al.Blastocyst culture is associated with an elevated incidence of monozygotic twinning after single embryo transfer［J］.Fertil Steril,2011,95(6):2140-2142.

［8］   Papanikolaou EG, Kolibianakis EM, Tournaye H, et al. Live birth rates after transfer of equal num-ber of blastocysts or cleavage-stage embryos in IVF［J］. A systematic review and meta-analysis,2008,23:91-99.

（2014-12-29 收稿    2015-01-18修回）［1］   Oque M, Lattes K, Serra S, et al. Fresh embryo transfer versus frozen embryo transfer in in vitro fertilization cycles: a systematic review and meta-analysis［J］. Fertil Steril,2013,99(1):156-62.

［2］   Zhu D, Zhang J, Cao S,et al. Vitrified-warmed blastocyst transfer cycles yield higher pregnancy and implantation rates compared with fresh blastocyst transfer cycles--time for a new embryo transfer strategy?［J］. Fertil Steril,2011,95(5):1691-1695.

［3］   Ae RH, Chan WP, Hyoung-Song L, et al.Blastocyst transfer in frozen-thawed cycles［J］. Clin Exp Reprod Med,2012,39(3):114-117.

［4］    Papanikolaou EG, Kolibianakis EM, Tournaye H, et al. Live birth rates after transfer of equal number of blastocysts or cleavage-stage embryos in IVF. A systematic review and meta-analysis［J］. Hum Reprod,2008,23(1):91-99.

［5］    Zander-Fox DL, Tremellen K, Lane M. Single blastocyst embryo transfer maintains comparable pregnancy rates to double cleavage-stage embryo transfer but results in healthier pregnancy outcomes［J］. Aust N Z J Obstet Gynaecol，2011,51(5):406-410.

［6］ Mullin CM, Fino ME, Talebian S, et al. Comparison of pregnancy outcomes in elective single blastocyst transfer versus double blastocyst transfer stratified by age[J]. Fertil steril, 2010, 93(6): 1837-1843.

［7］   Kawachiya S, Bodri D, Shimada N，et al.Blastocyst culture is associated with an elevated incidence of monozygotic twinning after single embryo transfer［J］.Fertil Steril,2011,95(6):2140-2142.

［8］   Papanikolaou EG, Kolibianakis EM, Tournaye H, et al. Live birth rates after transfer of equal num-ber of blastocysts or cleavage-stage embryos in IVF［J］. A systematic review and meta-analysis,2008,23:91-99.

（2014-12-29 收稿    2015-01-18修回）

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