CAJ | 학술논문

目的探讨1次移植3枚胚胎时造成三胎妊娠的风险因素.方法回顾分析769例一次性移植3枚胚胎周期资料,其中新鲜胚胎移植周期298例、冻融胚胎移植周期471例,分析不同周期类型、女方年龄和移植优胚数与临床妊娠率及三胎妊娠率的关系.结果 (1)冻融胚胎移植周期的临床妊娠率56.1%及三胎妊娠率10.2%均显著高于新鲜胚胎移植周期的临床妊娠率48.0%和三胎妊娠率4.2%(均P＜0.05);(2)新鲜胚胎移植周期中三胎妊娠均发生于年龄＜35岁组(P＜0.01);冻融胚胎移植周期年龄＜35岁和≥35岁组三胎妊娠率差异无统计学意义(P＞0.05);(3)新鲜胚胎移植周期移植优胚数分别为0、1、2、3枚时临床妊娠率分别为28.3%、46.7%、50.6%、58.7%,三胎妊娠率分别为0、2.3%、4.7%、6.8%,移植1枚优胚组与移植2枚优胚组临床妊娠率差异无统计学意义,但有较低的三胎妊娠率(P＜0.05);冻融胚胎移植周期移植优胚数分别为0、1、2、3枚时临床妊娠率分别为38.9%、54.8%、59.7%、63.9%,三胎妊娠率分别为0、5.0%、13.8%、15.8%,移植1枚优胚组与移植2枚优胚组相比临床妊娠率相近但三胎妊娠率显著降低(P＜0.05).三胎妊娠均发生于移植≥1枚优质胚胎周期(P＜0.05).结论冻融胚胎移植周期较新鲜胚胎移植周期易发生三胎妊娠;冻融胚胎移植周期可不考虑年龄因素,建议移植≤2枚胚胎,当有≥2枚优质胚胎移植时,建议行选择性单囊胚移植;新鲜胚胎移植周期当有优胚移植且年龄＜35岁时建议移植≤2枚胚胎.
목적 탐토1차이식3매배태시조성삼태임신적풍험인소.방법 회고분석769례일차성이식3매배태주기자료,기중신선배태이식주기298례、동융배태이식주기471례,분석불동주기류형、녀방년령화이식우배수여림상임신솔급삼태임신솔적관계.결과 (1)동융배태이식주기적림상임신솔56.1%급삼태임신솔10.2%균현저고우신선배태이식주기적림상임신솔48.0%화삼태임신솔4.2%(균P＜0.05);(2)신선배태이식주기중삼태임신균발생우년령＜35세조(P＜0.01);동융배태이식주기년령＜35세화≥35세조삼태임신솔차이무통계학의의(P＞0.05);(3)신선배태이식주기이식우배수분별위0、1、2、3매시림상임신솔분별위28.3%、46.7%、50.6%、58.7%,삼태임신솔분별위0、2.3%、4.7%、6.8%,이식1매우배조여이식2매우배조림상임신솔차이무통계학의의,단유교저적삼태임신솔(P＜0.05);동융배태이식주기이식우배수분별위0、1、2、3매시림상임신솔분별위38.9%、54.8%、59.7%、63.9%,삼태임신솔분별위0、5.0%、13.8%、15.8%,이식1매우배조여이식2매우배조상비림상임신솔상근단삼태임신솔현저강저(P＜0.05).삼태임신균발생우이식≥1매우질배태주기(P＜0.05).결론 동융배태이식주기교신선배태이식주기역발생삼태임신;동융배태이식주기가불고필년령인소,건의이식≤2매배태,당유≥2매우질배태이식시,건의행선택성단낭배이식;신선배태이식주기당유우배이식차년령＜35세시건의이식≤2매배태.
Objective To analyze the risk factors for triplet pregnancy after a simultaneous transfer of triplicate embryos. Methods The investigators carried out a retrospective analysis of 769 cycles in which three embryos were transferred in one treatment cycle, including 298 fresh embryo transfer (ET) cycles and 471 frozen-thawed ET (FET) cycles. The impact of patient age and the number of good embryos transferred on the rates of clinical pregnancy and triplet pregnancy was studied according to different cycle types. Results ( 1 ) The rates of clinical and triplet pregnancy were significantly higher in the FET group ( P ＜ 0. 05 ) than those in the fresh ET group; (2) all patients with a triplet pregnancy in the fresh ET group (n =6) were younger than 35 years old (P ＜ 0. 01 ). There was no significant difference between the subgroups in the FET cycle according to patient age ( P ＞ 0. 05 ); ( 3 ) when none, 1,2 or 3 good embryos were transferred in the fresh ET cycle, the clinical pregnancy rates were 28.3%, 46. 7%, 50. 6% and 58.7% and the triplet pregnancy rates 0, 2. 3%, 4. 7% and 6. 8% respectively. A similar clinical pregnancy rate (P ＞ 0. 05 ) and a significantly lower triplet pregnancy rate ( P ＜ 0. 05 ) were observed when 1 good embryo was transferred versus 2 good embryos ( P ＜ 0. 05 ). When 0, 1,2 or 3 good embryos were transferred in the FET cycle, the clinical pregnancy rates were 38.9%, 54. 8% , 59.7%, 63.9% and the triplet pregnancy rates 0, 5.0%,13.8%, 15.8% respectively. A similar clinical pregnancy rate (P ＞0. 05) and a significantly lower triplet pregnancy rate (P ＜ 0. 05 ) were observed when 1 good embryo was transferred versus two good embryos (P ＜ 0. 05 ). All triplet pregnancies occurred in cycles in which more than 1 good embryo was transferred (P ＜0. 05). Conclusion The patients have more triplet pregnancies in the FET cycle than in the fresh ET cycle. In the FET cycle, the patient age is irrelevant. It is recommended that no more than 2 embryos should be transferred. Selective single blastocyst embryo transfer is preferable if there are more than 2 good embryos available for transfer. No more than 2 embryos should be transferred in the fresh ET cycle if good embryos are available and a patient is under 35 years old.