CAJ | 학술논문

目的：比较不同获卵数患者2枚第3天(D3)胚胎移植和单囊胚移植的临床结局,为临床移植策略的选择提供数据支持。方法回顾性分析2014年1月至2014年12月在郑州大学第三附属医院生殖医学科行体外受精/卵胞浆内单精子显微注射(IVF/ICSI)治疗的患者,根据获卵个数分为3组,A 组获卵个数为5~9枚卵子,B 组为10~14枚卵子,C 组为≥15枚卵子。每组患者均有4种不同的移植方式,移植2枚 D3胚胎(a)、移植1枚囊胚(b)、复苏移植2枚冷冻 D3胚胎(c)和复苏移植1枚冷冻囊胚(d)；比较3组患者卵子的2PN 受精率、可移植胚胎率及优质胚胎率；比较各组患者4种移植方式的胚胎种植率、生化妊娠率、临床妊娠率、多胎率和流产率等差异。结果①A 组、B 组和 C组分别有667、573、479个移植周期,其中 A 组患者 IVF 的2PN 受精率和可移植胚胎率明显高于 B 组和 C 组(P =0.003/P <0.001)；②A 组患者4种移植方式的生化妊娠率、临床妊娠率和流产率差异均无统计学意义(P >0.05),但c 的种植率明显低于 a 和 d(P =0.027/0.020)；B 组患者中 d 的种植率明显高于 a 和 c(P =0.005/0.001)；C 组患者中d 的生化妊娠率和临床妊娠率均明显高于 a(P =0.048/0.027)和 c(P =0.003/0.001),且囊胚移植的种植率均明显高于 D3胚胎(P <0.05)；③3组患者单囊胚移植多胎率较胚胎移植明显降低(P <0.05)。结论对卵巢高反应人群(获卵数≥15枚),单囊胚移植在保证高种植率和妊娠率的同时,明显降低了多胎率；而获卵数为5~9枚和10~14枚的患者,D3胚胎移植的临床妊娠率和单囊胚移植相似,但多胎率明显增高；D3胚胎培养囊胚后择期移植具有较高的临床妊娠率,对于获卵数≥10枚患者是最佳的移植方案。
목적：비교불동획란수환자2매제3천(D3)배태이식화단낭배이식적림상결국,위림상이식책략적선택제공수거지지。방법회고성분석2014년1월지2014년12월재정주대학제삼부속의원생식의학과행체외수정/란포장내단정자현미주사(IVF/ICSI)치료적환자,근거획란개수분위3조,A 조획란개수위5~9매란자,B 조위10~14매란자,C 조위≥15매란자。매조환자균유4충불동적이식방식,이식2매 D3배태(a)、이식1매낭배(b)、복소이식2매냉동 D3배태(c)화복소이식1매냉동낭배(d)；비교3조환자란자적2PN 수정솔、가이식배태솔급우질배태솔；비교각조환자4충이식방식적배태충식솔、생화임신솔、림상임신솔、다태솔화유산솔등차이。결과①A 조、B 조화 C조분별유667、573、479개이식주기,기중 A 조환자 IVF 적2PN 수정솔화가이식배태솔명현고우 B 조화 C 조(P =0.003/P <0.001)；②A 조환자4충이식방식적생화임신솔、림상임신솔화유산솔차이균무통계학의의(P >0.05),단c 적충식솔명현저우 a 화 d(P =0.027/0.020)；B 조환자중 d 적충식솔명현고우 a 화 c(P =0.005/0.001)；C 조환자중d 적생화임신솔화림상임신솔균명현고우 a(P =0.048/0.027)화 c(P =0.003/0.001),차낭배이식적충식솔균명현고우 D3배태(P <0.05)；③3조환자단낭배이식다태솔교배태이식명현강저(P <0.05)。결론대란소고반응인군(획란수≥15매),단낭배이식재보증고충식솔화임신솔적동시,명현강저료다태솔；이획란수위5~9매화10~14매적환자,D3배태이식적림상임신솔화단낭배이식상사,단다태솔명현증고；D3배태배양낭배후택기이식구유교고적림상임신솔,대우획란수≥10매환자시최가적이식방안。
Objective To compare the clinical outcomes of two D3 embryo and single blastocyst transfer in patients retrieving different oocytes, so as to provide data support for selecting a clinical transfer strategy. Methods We made a retrospective analysis of patients who underwent in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI)between January and December 2014 in the Reproductive Medicine Center,the Third Affiliated Hospital of Zhengzhou University.The patients were divided into three groups according to the number of oocytes received:Group A (5-9 oocytes),Group B (10 - 14 oocytes)and Group C (≥ 1 5 oocytes).Patients in each group all received four different transfer methods as follows:transfer of two fresh D3 embryos (a ),transfer of one fresh blastocyst (b ),transfer of two D3 frozen embryos (c ),and transfer of one frozen blastocyst (d ).We compared the 2PN fertilization rate of oocytes,rate of available embryos and rate of good embryos among the three groups.We also compared the embryo implantation rate,biochemical pregnancy rate,clinical pregnancy rate, multiplets rate and abortion rate among the four transfer methods in each group.Results ① There were 667, 573,and 479 transfer cycles in Group A,Group B and Group C,respectively.The 2PN fertilization rate of IVF and available embryos rate was significantly higher in Group A than in Group B and Group C (P =0.003/P <0.001).② There was no significant difference in biochemical pregnancy rate,clinical pregnancy rate or abortion rate with the four transfer methods in Group A (P >0.05),but the implantation rate of c was significantly lower than that of a and d (P =0.027/0.020),d had a higher implantation rate than a and c in Group B (P =0.005/0.001).In Group C,the biochemical pregnancy rate and clinical pregnancy rate of d were significantly higher than those of a (P =0.048/0.027)and c (P =0.003/0.001).Patients in Group C also had a higher implantation rate than D3 embryos (P <0.05).③ The multiple pregnancy rate of single blastocyst transfer decreased compared with D3 embryos transfer in the three groups (P <0.05).Conclusion Single blastocyst transfer has both higher implantation rate and lower multiple pregnancy rate in high response patients (1 5 or more oocytes received).For patients who received 5-9 and 10-14 oocytes,D3 embryos have a similar clinical pregnancy rate with that of single blastocyst but a higher multiple pregnancy rate.Single vitrified-warmed blastocyst transfer has a higher clinical pregnancy rate.It is the best transfer method for patients who received more than 10 oocytes.