CAJ | 학술논문

目的探讨年龄＜38岁及≥38岁患者,在新鲜或冻融胚胎移植周期中移植1和2枚D3胚胎时胚胎种植率、临床妊娠率、多胎妊娠率等的差异.方法回顾性分析浙江大学医学院附属邵逸夫医院生殖中心自2010年1月1日至2012年12月31日所有移植1和2枚D3胚胎共7465个周期资料,其中移植1枚胚胎周期1546个,移植2枚胚胎周期5919个；新鲜胚胎移植周期2447个,冻融胚胎移植周期5018个.结果 (1)年龄＜38岁患者移植2枚胚胎与移植1枚胚胎比较:无论新鲜或冻融胚胎移植周期,胚胎着床率差异均无统计学意义,临床妊娠率显著上升(新鲜胚胎移植周期53.3％及35.5％,冻融胚胎移植周期59.8％及38.0％,均P＜0.01)、双胎妊娠率显著上升(新鲜胚胎移植周期28.7％及0.6％,冻融胚胎移植周期:31.1％及3.0％,均P＜0.01)；(2)年龄≥38岁患者移植2枚胚胎与移植1枚胚胎比较:新鲜胚胎移植周期胚胎着床率显著上升(20.3％及9.5％,P ＜0.05),冻融胚胎移植周期胚胎着床率差异无统计学意义；临床妊娠率均显著升高(新鲜胚胎移植周期33.2％及9.5％,冻融胚胎移植周期39.0％及21.1％,均P＜0.01)；双胎妊娠率显著升高(新鲜周期19.4％、冻胚周期13.4％),移植1枚胚胎周期无双胎妊娠发生.结论年龄＜38岁患者移植2枚胚胎可显著提高临床妊娠率,但同时多胎妊娠风险显著增加,在充分知情同意情况下可以建议移植1枚胚胎；年龄≥38岁患者建议移植2枚胚胎.
목적 탐토년령＜38세급≥38세환자,재신선혹동융배태이식주기중이식1화2매D3배태시배태충식솔、림상임신솔、다태임신솔등적차이.방법 회고성분석절강대학의학원부속소일부의원생식중심자2010년1월1일지2012년12월31일소유이식1화2매D3배태공7465개주기자료,기중이식1매배태주기1546개,이식2매배태주기5919개；신선배태이식주기2447개,동융배태이식주기5018개.결과 (1)년령＜38세환자이식2매배태여이식1매배태비교:무론신선혹동융배태이식주기,배태착상솔차이균무통계학의의,림상임신솔현저상승(신선배태이식주기53.3％급35.5％,동융배태이식주기59.8％급38.0％,균P＜0.01)、쌍태임신솔현저상승(신선배태이식주기28.7％급0.6％,동융배태이식주기:31.1％급3.0％,균P＜0.01)；(2)년령≥38세환자이식2매배태여이식1매배태비교:신선배태이식주기배태착상솔현저상승(20.3％급9.5％,P ＜0.05),동융배태이식주기배태착상솔차이무통계학의의；림상임신솔균현저승고(신선배태이식주기33.2％급9.5％,동융배태이식주기39.0％급21.1％,균P＜0.01)；쌍태임신솔현저승고(신선주기19.4％、동배주기13.4％),이식1매배태주기무쌍태임신발생.결론 년령＜38세환자이식2매배태가현저제고림상임신솔,단동시다태임신풍험현저증가,재충분지정동의정황하가이건의이식1매배태；년령≥38세환자건의이식2매배태.
Objective To separately evaluate the embryo implantation rate (IR),clinical pregnancy rate and multiple pregnancy rate between women ＜ 38 years old or ≥ 38 years old in fresh or frozen thawed embryo transfer cycles,or in single or double embryo transfer cycles.Methods A total of 7465 single or double embryo transfer cycles between January 2010 and December 2012 at Affiliated Sir Run Run Shaw Hospital,Zhejiang University were analyzed.There were 1546 single embryo transfer cycles and 5919 double embryo transfer cycles; 2447 fresh embryo transfer cycles and 5018 frozen-thawed embryo transfer cycles.Results (1) Regardless of whether fresh or frozen-thawed embryo was used for transfer,there was no significant difference in embryo implantation rate between single and double embryo transfer groups in women ＜ 38 years.The clinical pregnancy rate significantly increased if double embryos were replaced (fresh embryo transfer,53.3％ vs 35.5％ ; frozen-thawed embryo transfer,59.8％ vs 38.0％,P ＜0.01).Twin pregnancy rate also significantly increased (fresh embryo transfer,28.7％ vs 0.6％;frozen-thawed embryo transfer,31.1％ vs 3.0％,P ＜0.01) ; (2) embryo implantation rate in fresh embryo transfer significantly increased in women ≥ 38 years old between groups of single or double embryo transfer (20.3％ vs 9.5％,P ＜0.05).No significant difference existed in IR for frozen-thawed embryo transfer.The clinical pregnancy rate significantly increased (P ＜ 0.01) if double embryos were replaced (fresh embryo transfer,33.2％ vs 9.5％ ; frozen-thawed embryo transfer,39.0％ vs 21.1％,P ＜0.01).Twin pregnancy rate was 19.4％ in fresh embryo transfers versus 13.4％ in frozen-thawed embryo transfers.There was no twin pregnancy in single embryo transfers.Conclusion Compared with single embryo transfer in women ＜ 38 years,double embryo transfer can significantly increase the rates of clinical pregnancy nd twin pregnancy.Decision is made after thorough consultations and single embryo transfer is justifiable.Double embryo transfer is indicated for women ≥38 years.