>40岁女性冻融囊胚移植数目的选择策略  

The strategy of frozen-thawed blastocyst transfer in women over 40 years

作　　者：朱秀兰[1] 张曦倩[1] 周睿琼 黄莉[1] 许虹[1] 肖宗辉[1] 刘风华[1] Zhu Xiulan;Zhang Xiqian;Zhou Ruiqiong;Huang Li;Xu Hong;Xiao Zonghui;Liu Fenghua(Reproductive Center,Guangdong Maternal and Child Health Hospital,Guangzhou 511442,China)

机构地区：[1]广东省妇幼保健院生殖中心,广州511442

出　　处：《中国医师杂志》2021年第9期1299-1302,共4页Journal of Chinese Physician

摘　　要：目的探讨>40岁女性冻融周期囊胚移植数目的选择策略,为降低双胎率、提高围产期临床结局提供参考。方法回顾性分析2017年1月至2019年12月在广东省妇幼保健院生殖中心年龄>40岁、接受冻融囊胚移植的377个移植周期患者,根据囊胚移植数目分为单囊胚和双囊胚移植组。比较两组临床妊娠率、种植率、流产率、活产率、早产率、双胎率及单胎分娩率。结果⑴两组取卵年龄、移植年龄、BMI、基础窦卵泡数(AFC)、基础卵泡刺激素(FSH)、抗苗勒氏管激素(AMH)、移植日子宫内膜厚度、获卵数、Gn启动剂量、Gn天数、Gn用量、优质胚胎数、D3可利用胚胎数比较差异均无统计学意义(P>0.05);⑵两组种植率、早期流产率、晚期流产率、活产率比较差异无统计学意义(P>0.05);⑶双囊胚组早产率(31.71%)明显高于单囊胚组(12.5%),但差异无统计学意义(P=0.083);⑷双囊胚组临床妊娠率、双胎妊娠率高于单囊胚组,差异有统计学意义(P<0.05);⑸双囊胚组单胎分娩率(75.61%)低于单囊胚组(95.83%),差异有统计学意义(P=0.036)。结论>40岁女性囊胚冻融移植,可选择单囊胚移植,保证活产率相当的情况下明显降低双胎率、提高单胎分娩率等围产期结局。Objective To explore the selection strategy of blastocyst transfer number in freeze-thaw cycle for women over 40 years old,so as to provide reference for reducing twin rate and improving perinatal clinical outcome.Methods A retrospective analysis was made of 377 patients who underwent freeze-thaw blastocyst transplantation in the reproductive center of Guangdong Maternal and Child Health Hospital from January 2017 to December 2019.They were divided into single blastocyst and double blastocyst transplantatio groups according to the number of blastocyst transplantation.The clinical pregnancy rate,implantation rate,abortion rate,live birth rate,premature delivery rate,twin rate and singleton delivery rate were compared between the two groups.Results⑴There was no significant difference between two groups regarding the majority of baseline characteristics,including age at retrieval,age at transfer,body mass index(BMI),antral follicle count(AFC),basal follicle stimulating hormone(FSH),anti Mullerian hormone(AMH),endometrial thickness at transfer day,number of oocytes retrieved,Gn starting dose,Gn days,Gn dosage,embryos at cleavage stage and top-quality embryos(P>0.05).⑵There was no significant difference in the rate of implantation,early pregnancy loss,late pregnancy loss and live birth between two groups(P>0.05).⑶The preterm birth rate was higher in the double blastocyst transplantation group compared with the single blastocyst transplantation group,albeit not reaching significant difference(31.7%vs 12.5%,P=0.083).⑷The clinical pregnancy rate and the twin pregnancy rate was significantly higher in the double blastocyst transplantation group compared with the single blastocyst transplantation group(P<0.05).⑸The singleton birth rate was significantly lower in the double blastocyst transplantation group compared with the single blastocyst transplantation group(75.61%vs 95.83%,P<0.05).Conclusions In women≥40 years old,transferring a single blastocyst can result in live birth rate that is similar as transferrin

关 键 词：妊娠 双胎 选择性单胚胎移植 活产率 冻融囊胚移植 

分 类 号：R714.8[医药卫生—妇产科学]