38岁以上不孕女性ART新鲜周期优选移植策略的探讨  

Discussion on the optimal transplantation strategy of ART fresh cycle in infertile women over 38 years old

作　　者：王安然 万江帆 莫似恩 李肖然 刘雪媛 石明华 李柳铭 Wang Anran;Wan Jiangfan;Mo Sien;Li Xiaoran;Liu Xueyuan;Shi Minghua;Li Liuming(Reproductive Center,The Reproductive Hospital of Guangxi Zhuang Autonomous Region,Nanning Guangxi 530029,P.R.China;Center of Reproductive Medicine,The First Affiliated Hospital of Guangxi Medical University,Nanning Guangxi 530021,P.R.China)

机构地区：[1]广西壮族自治区生殖医院生殖医学科,广西南宁530029 [2]广西医科大学第一附属医院生殖医学研究中心,广西南宁530021

出　　处：《中国计划生育和妇产科》2022年第2期52-55,59,共5页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的探讨≥38岁不孕女性在辅助生殖技术(assisted reproductive technology, ART)新鲜周期优选单囊胚移植与双卵裂期胚胎移植的效果。方法回顾性分析2019年1~12月在广西壮族自治区生殖医院≥38岁不孕女性新鲜周期双卵裂期胚胎(A组:2D3,621例)和单囊胚(B组:1D5-6,71例)移植患者的ART病例资料,比较其一般资料、促排卵情况、胚胎发育情况和妊娠结局。结果 B组患者正常受精率、优质胚胎率、移植优胚率均低于A组(P<0.05);两组的临床妊娠率、活产率、早晚期流产率、早产率、极低出生体重儿出生率、平均出生体重比较,差异无统计学意义(P>0.05),B组的种植率高于A组,且多胎率较A组低(P<0.05);≥4个优胚患者中B组的种植率明显高于A组(P<0.05)。结论为了降低多胎妊娠率,当新鲜周期ART≥38岁不孕女性D3优质胚胎≥4个,建议优选单囊胚移植;而当D3优质胚胎≤3个,在充分医患沟通的条件下,则建议谨慎选择双卵裂期胚胎移植。Objective To explore the transfer strategy of single blastocyst transfer or double cleavage embryo transfer in assisted reproductive technology(ART) fresh cycle for infertile women ≥38 years old.Methods To retrospectively analyze the general data, the status of induced ovulation, embryo development and pregnancy outcome of ART in infertile women ≥38 years old with fresh cycle double cleavage embryos(group A:2D3,621 cases) and single blastocysts(group B:1D5-6,71 cases) transplanted in Reproductive Hospital of Guangxi Zhuang Autonomous Region in 2019.Results The normal fertilization rate and the rate of high-quality embryos, high-quality embryo rate for transplantation in group B were lower than those in group A(P<0.05);the clinical pregnancy rate, live birth rate, early abortion rate, late abortion rate, and premature birth rate, very low birth weight infant birth rate, average birth weight in the two groups were similar(P>0.05).The implantation rate of group B was higher than that of group A,and the multiple pregnancy rate was lower than that of group A(P<0.05);Among≥4 high-quality embryos, the implantation rate of group B was significantly higher than that of group A(P<0.05).Conclusion In order to reduce the rate of multiple pregnancy, fresh cycle ART≥38-year-old infertile women with ≥4 D3 high-quality embryos, it is recommended to prefer single blastocyst transfer;While D3 ≤3 high-quality embryos, it is recommended to choose double cleavage stage transfer under the conditions of sufficient doctor-patient communication carefully.

关 键 词：≥38岁 单囊胚移植 双卵裂期胚胎移植 多胎妊娠率 

分 类 号：R711.6[医药卫生—妇产科学]