降低体外受精-胚胎移植多胎妊娠的策略及效果分析  

Strategy and Its Outcomes in Reducing the Multiple Pregnancy Rates of IVF/ICSI

作　　者：张波[1] 冯贵雪[1] 周红[1] 伍芳蓉[1] 甘贤优[1] 舒金辉[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5期399-403,共5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;重2011063;重2011065)

摘　　要：目的:研究选择性囊胚培养与单囊胚移植(eBC-SBT)降低多胎率的作用。方法:对2009年1月—2010年12月收治行体外受精/胞浆内单精子注射(IVF/ICSI)助孕,评估预后较好且高危双胎妊娠风险患者进行一对一知情告知,根据患者的意愿分为单囊胚移植组和卵裂胚移植组,分析2组间的种植率、临床妊娠率、多胎率及单卵双胎率等指标,同时对干预前、干预后总体的种植率、临床妊娠率、多胎率进行研究。结果:①囊胚移植组与卵裂胚移植组间患者年龄、胚胎冷冻率差异无统计学意义(P>0.05),但单囊胚移植较双卵裂期胚胎移植(ET)的种植率更高(52.4%vs.43.4%,P<0.05),尽管临床妊娠率有所降低(52.4%vs.60.1%,P>0.05),但前者的多胎率明显降低(3.3%vs.44.2%,P<0.05),早产率、低体质量儿出生率降低(P<0.01),足月单胎活产率提高(P<0.01)。②干预前、干预后2组间患者的平均年龄、获卵数和冷冻率差异均无统计学意义(P>0.05),干预后移植胚胎数显著下降。胚胎种植率(26.2%vs.34.6%,P<0.01)、总体临床妊娠率(42.4%vs.47.1%,P<0.05)及活胎分娩率(30.6%vs.38.0%,P<0.01)提高,而多胎妊娠率(30.9%vs.17.3%,P<0.01)和低体质量儿出生率(30.7%vs.24.0%,P<0.05)显著降低。结论:选择性囊胚培养与单囊胚移植能在有效维持总体临床妊娠率的前提下显著降低IVF-ET的多胎率,改善妊娠结局。Objective：To investigate the effects of elective blastocyst culture and single blastocyst transfer（eBC-SBT） on the reduction of multiple pregnancy rate.Methods： Patients undergoing in vitro fertilization（IVF） or intracytoplasmic sperm injection（ICSI） in our center from January 2009 to December 2010 were analyzed.Patients with good prognosis and high risk of multiple pregnancy were advised to receive eBC-SBT with the consent.Patients who refused to perform eBC-SBT and did not meet the criteria were transferred day-3 cleavage embryos.The implantation rate,clinical pregnancy rate and multiple pregnancy rate were compared between the two groups.Results： ①The age of patients and embryo vitrifaction rate were similar between two groups（P〉0.05）.The implantation rate and live birth rate in the eBC-SBT group were significantly increased when compared to the D3 cleavage group（52.4% vs.43.4%,P〈0.05）.Though the clinical pregnancy rate（52.4% vs.60.1%,P〈0.05） slightly decreased in the eBC-SBT group,the multiple pregnancy rate（3.3% vs.44.2%,P〈0.05）,preterm delivery and low weight birth significantly decreased when compared to the D3 cleavage group（P〈0.05）.②No significant differences in maternal age,number of oocytes and embryo vitrification rate were observed between two periods（P〉0.05）.The implantation rate（26.2% vs.34.6%,P〈0.05）,clinical pregnancy rate（42.4% vs.47.1%,P〈0.05） and live birth rate（30.6% vs.38.0%,P〈0.05） of the eBC-SBT group were higher,while the multiple pregnancy rate（30.9% vs.17.3%,P〈0.05） and low weight birth rate（30.7% vs.24.0%,P〈0.05） were lower,than those of anterior period.Conclusions： The strategy of eBC-SBT can effectively reduce the multiple pregnancy rate,and improve the outcome of pregnancy,but do not decrease the clinical pregnancy rate.

关 键 词：囊胚 胚胎培养技术 胚胎移植 妊娠 多胎 妊娠率 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]