选择性单囊胚移植在降低多胎率中的应用  

Value of Elective Single Blastocyst Transfer in Reducing Multiple Pregnancy Rates in IVF/ICSI Patients

作　　者：张波[1] 冯贵雪[1] 周红[1] 伍芳蓉[1] 

机构地区：[1]广西壮族自治区妇幼保健院生殖中心,南宁530003

出　　处：《国际生殖健康／计划生育杂志》2012年第1期38-41,共4页Journal of International Reproductive Health/Family Planning

基　　金：广西自然科学基金(桂科攻0897007;桂科自0832183;桂科自0542058);广西卫生厅重点课题(重200947)

摘　　要：目的:探讨选择性囊胚培养与单囊胚移植(eBC-SBT)对妊娠结局、多胎妊娠率和单卵双胎率的影响。方法:按实施选择性囊胚培养与单囊胚移植技术的前、后,分为干预组(对预后良好、高危多胎妊娠风险的患者建议行选择性囊胚培养,自愿者行囊胚培养,其余患者于第3天移植)和非干预组(全部患者移植第3天卵裂期胚胎)。第5天或第6天对接受eBC-SBT患者的囊胚进行评级,评为BB及其以上级别的囊胚,予单囊胚移植;评为BC及以下级别的囊胚,予双囊胚移植。分析eBC-SBT对种植率、临床妊娠率、多胎率及单卵双胎率等的影响。结果:①干预组和非干预组患者的年龄、获卵数及受精率差异无统计学意义(P>0.05),干预后移植胚胎数降低([1.60±0.56)vs(.2.17±0.51),P<0.01],种植率(33.75%vs.25.69%)和临床妊娠率(47.31%vs.40.84%)均提高(P<0.05),多胎率降低(15.38%vs.29.37%,P<0.01)。②干预后,选择性单囊胚移植组移植胚胎数低于卵裂期胚胎移植组([1.09±0.28)vs(.1.96±0.40),P<0.01],前者种植率提高(43.99%vs.30.18%,P<0.01),2组临床妊娠率差异无统计学意义(47.35%vs.47.29%,P>0.05),但多胎率降低(0.86%vs.24.59%,P<0.01)。③干预组和非干预组的单卵双胎发生率差异无统计学意义(1.32%vs.1.67%,P>0.05)。在干预组中,选择性单囊胚移植患者的单卵双胎率与卵裂期胚胎移植组的差异亦无统计学意义(2.59%vs.1.09%,P>0.05)。结论:eBC-SBT能显著降低多胎率,有效维持总体临床妊娠率,且未见单卵双胎率异常增高。Objective：To investigate the effects of elective blastocyst culture and single blastocyst transfer（eBC-SBT） on the clinical pregnancy rate（CPR）,multiple pregnancy rate（MPR） and monozygotic twinning rate（MZTR）.Methods：According to whether the eBC-SBT was applied,patients from January 2007 to November 2009 were divided into two groups：no-intervention group and intervention group.For the no-intervention group,Day-3 cleavage embryos were transferred before the intervention of the eBC-SBT program.For the intervention group,patients with good prognosis and high risk of multiple pregnancy were advised and received eBC-SBT on their own.On the morning of Day-5 or Day-6,blastocysts were assigned a score according to their degree of expansion and hatching status,inner cell mass,and trophoectoderm.One blastocysts would be transferred if at least one blastocysts were graded BB or better,while two blastocysts would be transferred if blastocysts were just graded BC.Those refused to perform eBC-SBT and not met the criteria were transferred Day-3 cleavage embryos.The CPR,MPR and MZTR of the no-intervention group versus the intervention group and Day-3 embryo transfer versus blastocyst transfer in the intervention group were compared.Results：①The age of patients,number of oocytes and fertilization rate were similar between the intervention group with eBC-SBT and the no-intervention group（P0.05）.Compared with the no-intervention group,the intervention group had fewer number of transferred embryos（1.60±0.56 vs.2.17±0.51,P0.01）,higher implantation rate（33.75% vs.25.69%） and clinical pregnancy rate（47.31% vs.40.84%）（P0.05）,and much lower MPR（15.38% vs.29.37%,P0.01）.②In the intervention group,fewer embryos were transferred at the blastocyst stage when compared with Day-3 embryo transfer（1.09±0.28 vs.1.96±0.40,P0.01）,implantation rate was higher（43.99% vs.30.18%,P0.01） and clinical pregnancy rate was similar（47.35% vs.47.29%,P0.05）,while the MPR of the blastocyst transf

关 键 词：囊胚 胚胎移植 双生 单卵 受精 体外 生殖技术 辅助 

分 类 号：R714.8[医药卫生—妇产科学]