新鲜周期D3卵裂期胚胎移植策略的选择  

Selectionof transfer strategies for D3 cleavage-stage embryos in fresh cvcles

作　　者：王秦[1] 卢美松[1] 刘彬[1] 张洪秀[1] 张晓磊[1] Wang Qin;Lu Meisong;Liu Bin;Zhang Hongxiu;Zhang Xiaolei(Department of Reproductive Medicine,the First Afiliated Hospital of Harbin Medical University,Harbin Heilongjiang 150001,P.R.China)

机构地区：[1]哈尔滨医科大学附属第一医院生殖医学科,黑龙江哈尔滨150001

出　　处：《中国计划生育和妇产科》2023年第7期90-95,共6页Chinese Journal of Family Planning & Gynecotokology

摘　　要：目的对比新鲜周期不同D3卵裂期胚胎移植策略的妊娠结局,优化移植策略。方法回顾性分析2016年1月至2021年12月于哈尔滨医科大学附属第一医院生殖医学科行常规体外受精/卵胞浆内单精子显微注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)助孕且为第一促排周期并行新鲜周期移植的2251例患者的临床资料。根据移植胚胎个数及移植胚胎的质量不同分为移植两枚D3优质胚胎组(A组),移植1枚D3优质胚胎+1枚D3非优质胚胎组(B组),移植2枚D3非优质胚胎组(C组)和移植1枚D3优质胚胎组(D组)。根据患者年龄分层,各组均再分为两个亚组,分别为≤35岁组和≥36岁组,对比各组间妊娠结局。结果A、B、C、D四组患者活产率、临床妊娠率、种植率、多胎率、早期流产率和早产率比较,差异均有统计学意义(P<0.05)。在≤35岁患者亚组中,A1组、B1组、C1组和D1组活产率、临床妊娠率、种植率、多胎率、早期流产率和早产率比较,差异均有统计学意义(P<0.05)。A1组活产率高于B1组和D1组(P=0.003、P<0.001),B1组和D1组活产率差异无统计学意义(P=0.021);A1组与B1组临床妊娠率高于D1组(P均<0.001);A1组的种植率高于B1组(P=0.004),与D1组差异无统计学意义(P=0.541);A1组与B1组的多胎率和早产率均高于D1组(P<0.001、P<0.001,P=0.011、P=0.007);B1组的早期流产率高于A1组(P=0.004)。在≥36岁患者亚组中,A2组、B2组、C2组和D2组活产率、临床妊娠率、种植率和多胎率比较,差异均有统计学意义(P<0.05),而早期流产率和早产率比较,差异无统计学意义(P>0.05)。A2组的活产率和妊娠率高于D2组(P=0.011、0.001)。A2组种植率高于B2组(P=0.003)。A2组多胎率高于D2组(P=0.008)。各组间早期流产率和早产率差异无统计学意义(P>0.05)。活产的二分类多因素Logistic回归分析结果显示,不同胚胎移植策略、年龄以及不同促排卵方案均是活产的独立影响�Objective Optimize the transfer strategy by comparing the pregnancy outcomes of different D3 cleavage-embryo transfer strategies in fresh cycles.Methods In this retrospective study,2251 patients who received conventional in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)assisted reproduction treatment for the first ovulation cycle at the Reproductive Department of the First Afiliated Hospital of Harbin Medical University from January 2016 to December 2021 were involved.According to the number and quality of embryos transferred,the patients were divided into four groups:double D3 high-quality embryo group(group A),one D3 high-quality embryo plus one non-high-quality embryo group(group B),double D3 non-high-quality embryo group(group C)and single D3 high-quality embryo group(group D).According to the age of the patients,each group was subdivided into two subgroups:≤35 years old and≥36 years old,and the pregnancy outcomes among the groups were compared.Results There were statistical differences in live birth rate,clinical pregnancy rate,implantation rate,multiple pregnancy rate,early abortion rate,and premature delivery rate among groups A,B,C,and D(P<0.05).In the subgroup of patients≤35 years old,there were statistical differences in live birth rate,clinical pregnancy rate,implantation rate,multiple pregnancy rate,early abortion rate,and premature delivery rate among groups A1,B1,C1,and D1(P<0.05).The live birth rate in group A1 was higher than that in group Bl and group D1(P=0.003,P<0.001),while there was no statistical difference between group B1 and group D1(P=0.021).The clinical pregnancy rates in group A1l and BI were higher than that in group D1(P<0.001,P<0.001).The implantation rate in group A1 was higher than that in group B1(P=0.004),but there was no statistical difference between group A1 and group D1(P=0.541).The multiple pregnancy rate and premature birth rate in group Al and group B1 were higher than those in group D1(P<0.001,P<0.001,P=0.011,P=0.007).The early abortion rate in grou

关 键 词：移植策略 新鲜胚胎移植 优质胚胎 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]