Clinical outcomes for Day 3 double cleavage-stage embryo transfers versus Day 5 or 6 single blastocyst transfer in frozen–thawed cycles: a retrospective comparative analysis

ObjectiveThis study aimed to compare the clinical outcomes for transfer of Day 3 (D3) double cleavage-stage embryos and Day 5/6 (D5/6) single blastocysts in the frozen embryo transfer (FET) cycle to formulate a more appropriate embryo transplantation strategy.MethodsWe retrospectively analyzed 609 FET cycles from 518 women from April 2017 to March 2021. All FETs were assigned to the D3-DET group (transfer of a Day 3 double cleavage-stage embryo), D5-SBT group (transfer of a Day 5 single blastocyst), or D6-SBT group (transfer of a Day 6 single blastocyst). Clinical outcomes were comparatively analyzed.ResultsThere were no significant differences in the biochemical pregnancy rate, clinical pregnancy rate, or ongoing pregnancy rate between the D3-DET and D5-SBT groups, but these rates in the two groups were all significantly higher compared with those in the D6-SBT group. The implantation rate in the D5-SBT group was significantly higher than that in the D3-DET group. The twin pregnancy rate in the D5-SBT and D6-SBT groups was significantly lower than that in the D3-DET group.ConclusionThis study suggests that D5-SBT is the preferred option for transplantation. D6-SBT reduces the pregnancy rate, making it a more cautious choice for transfer of such embryos.     

Comparative study on the pregnancy outcomes of in vitro fertilization–embryo transfer between long-acting gonadotropin-releasing hormone agonist combined with transvaginal ultrasound-guided cyst aspiration and long-acting gonadotropin-releasing hormone agonist alone

ObjectiveTo retrospectively analyze the effects of long-acting gonadotropin-releasing hormone agonist (GnRH-a) combined with transvaginal ultrasound-guided cyst aspiration on the pregnancy outcomes of in vitro fertilization–embryo transfer (IVF–ET) in the infertile patients with ovarian endometriosis.MethodsThe 134 patients with ovarian endometriosis who underwent GnRH-a combined with transvaginal ultrasound-guided cyst aspiration and IVF–ET were served as experimental group. The 102 patients with ovarian endometriosis who underwent GnRH-a and IVF–ET were served as control group. After treatment, the cyst size, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), number of ovum pick-up, fertility rate, cleavage rate, high-quality embryo rate, implantation rate, clinical pregnancy rate and abortion rate were compared between the two groups.ResultsIn the 134 patients of experimental group, 138 cysts disappeared after GnRH-a combined with three times of transvaginal ultrasound-guided cyst aspiration. In the 102 patients of control group, of the 114 cysts, 34 disappeared after GnRH-a, 67 were decreased and 13 were unchanged. The abortion rate was significantly lower in experimental group than in control group. The level of serum E2 on HCG day, the number of ovarian follicles with 14 mm or more, the number of retrieved oocytes, high-quality embryo rate, implantation rate and clinical pregnancy rate were higher in experimental group than in control group (all P < 0.05).ConclusionGnRH-a combined with transvaginal ultrasound-guided cyst aspiration can obtain better therapeutic effects and pregnancy outcomes in infertile patients with ovarian endometriosis who underwent IVF–ET.     

不同来源精子行体外受精/卵胞浆内单精子显微注射所得胚胎冻融及移植后妊娠结局比较

目的分析体外受精（IVF）与不同来源精子卵胞浆内单精子显微注射（ICSI）所得胚胎在冻融及移植后的情况。方法选择2007年3月至2009年8月我院生殖中心进行复制的107例患者共131个冻融胚胎移植（FET）周期,据FET胚胎来源分为IVF组、ICSI组;ICSI组又分射出精子组（A组）、附睾精子组（B组）、睾丸精子组（C组）。结果IVF组与ICSI组胚胎存活率、移植胚胎占解冻胚胎比例、平均移植胚胎数、临床妊娠率、胚胎种植率、流产率比较,差异均无显著性意义（P〉0.05）;A、B、C组胚胎存活率、移植胚胎占解冻胚胎比例、平均移植胚胎数、胚胎种植率比较,差异均无显著性意义（P〉0.05）;B、C组临床妊娠率比较,差异无显著性意义（P〉0.05）,但均明显高于A组（P〈0.05）;A组患者62.5%存在女方不孕因素,比例明显高于B、C组（P〈0.05）。结论IVF和不同来源精子行ICSI所得的优质胚胎经受冷冻解冻的能力没有差异;ICSI所得胚胎行FET时,女方同时存在不孕因素是影响妊娠率的因素之一。     

早期补救卵胞浆内单精子注射在常规受精失败周期中的应用

目的评估早期补救卵胞浆内单精子注射(r-ICSI)在常规体外受精(IVF)失败(低下)中的有效性。方法对59周期因全部受精失败或受精率低下进行早期r-ICSI受精(部分受精失败38周期,全部受精失败21周期)的不孕患者资料进行回顾性分析,统计其受精率、卵裂率、胚胎质量、妊娠率及种植率,与同期常规ICSI周期的数据进行比较。结果与同期299ICSI周期相比,早期r-ICSI组受精率、2PN率、胚胎率、优质胚胎率、临床妊娠率和胚胎种植率均无明显差异,3PN率r-ICSI组明显升高。结论对常规IVF失败(低下)患者进行早期-rICSI受精可以得到正常受精、胚胎发育及妊娠,为患者提供了更多的妊娠机会,可以考虑作为IVF实验室的常规操作。     

Single-dose administration of a short-acting gonadotropin-releasing hormone agonist does not affect cycle outcome in frozen–thawed embryo transfer cycles

ObjectiveThis prospective study aimed to assess the effect of short-acting gonadotropin-releasing hormone agonist (GnRHa) administration on pregnancy outcomes in frozen–thawed embryo transfer (FET) cycles.MethodsPatients who planned to have FET in Peking Union Medical College Hospital (China) were recruited for this study and randomly assigned into two groups. Patients in the experimental group (n = 460) received triptorelin acetate on the day of embryo transfer along with routine luteal support. Patients in the control group (n = 433) only received luteal support. One dose (0.1 mg) of a short-acting GnRHa was administered on the day of blastocyte transfer. The rates for clinical pregnancy, biochemical pregnancy, implantation, miscarriage, and ectopic pregnancy were compared between the groups.ResultsThere were no significant differences in the number and quality of blastocytes transferred between the two groups. In the experimental and control groups, the clinical pregnancy rate was 56.3% and 50.58%, the biochemical pregnancy rate was 15.78% and 18.94%, and the median implantation rate was 39.98% and 38.01%, respectively, with no significant difference between the groups. Biochemical pregnancy and abortion and the ectopic pregnancy rate were not significantly different between the two groups.ConclusionIn FET cycles, a GnRHa does not affect the pregnancy outcome.     

年龄和内膜准备法对冻融胚胎移植妊娠率的影响

目的探讨不同年龄段和不同内膜准备方法对冻融胚胎移植（FET）妊娠率的影响。方法回顾性分析2007年3月-2009年8月107例患者131个FET周期,比较不同年龄段、不同内膜准备方法的妊娠情况。结果①〈29岁、30～34岁、≥35岁患者的周期临床妊娠率分别为45.28%、37.88%、33.33%,比较无统计学意义（P〉0.05）。②自然周期和激素替代周期内膜准备,两种方法患者平均年龄、平均移植胚胎数、胚胎评分及胚胎细胞数比较无统计学意义（P〉0.05）,但自然周期的胚胎种植率及周期临床妊娠率均明显低于激素替代周期（16.78%比29.21%;29.51%比50.00%）,比较有统计学意义（P〈0.05）。结论患者年龄不影响FET周期临床妊娠率,激素替代周期内膜准备的FET胚胎种植率及周期临床妊娠率明显高于自然周期。     

大Y染色体对体外受精与胚胎移植的影响

目的：探讨在体外受精与胚胎移植中大Y染色体对其受精方式及结局的影响。方法：对2001年3月至2003年6月在我院生殖中心进行体外受精／卵胞浆内单精子注射-胚胎移植（IVF／ICSI-ET）助孕的113例患者（共127个周期治疗）进行前瞻性研究，大Y染色体组（A组）共56个治疗周期，染色体正常组（B组）共71个治疗周期；A组中精液常规正常者共24个治疗周期，随机分为IVF组（A1组）共13个治疗周期，ICSI组（A2组）共11个治疗周期。结果：（1）A、B两组间受精率、卵裂率、移植胚胎质量、临床妊娠率、种植率、流产率、异位妊娠率、死婴出生率、畸形率、男婴出生比例及女婴出生比例，差异无显著性（P〉0．05）；（2）A1、A2两组间受精率，差异无显著性（P〉0．05）。结论：大Y染色体对IVF／ICSI-ET的选择、胚胎发育及近期妊娠结局无明显影响。     

短时受精与常规受精对体外受精结局的影响

目的:比较不孕患者行短时受精与常规受精的临床结局,从而评估短时受精在体外受精中的临床应用价值.方法:回顾性分析2008年1月至2010年7月在我院生殖中心进行体外受精-胚胎移植(IVF-ET)治疗的不孕患者资料,短时受精周期217例(Ⅰ组),常规受精周期413例(Ⅱ组),两组患者均为首次接受IVF-ET治疗.结果:Ⅰ组获卵3 007枚,受精率、正常受精率、多原核受精率、卵裂率、优质胚胎率、种植率、临床妊娠率、冷冻周期率分别为77.79％、62.82％、14.97％、97.27％、64.39％、32.35％、48.39％、79.26％,Ⅱ组获卵5 586枚,受精率、正常受精率、多原核受精率、卵裂率、优质胚胎率、种植率、临床妊娠率、冷冻周期率分别为77.68％、63.73％、13.95％、97.27％、59.69％、33.63％、48.18％、72.88％.两者的受精率、正常受精率、多原核受精率、卵裂率、种植率、临床妊娠率、冷冻周期率比较差异无统计学意义(P＞0.05),而Ⅰ组的优质胚胎率与Ⅱ组比较差异有统计学意义(P＜0.05).结论:短时受精可以为临床提供更多的优质胚胎,而不影响周期的正常受精率.     

卵细胞与胞浆内精子注射胚胎体外发育情况分析

目的:比较传统的体外受精(IVF)与胞浆内精子注射(ICSI)胚胎体外发育情况。方法:1.将同一病人卵子随机平均分为两部分,分别实施IVF与ICSI技术,比较两组受精率与优质胚胎率。2.回顾性分析154例IVF与34例ICSI胚胎体外发育情况,比较两组受精率与优质胚胎率。结果:1.分组比较结果显示,IVF组与ICSI组受精率相比,以总卵子数计算未见显著性差异[63.0％(87/138)与65.2％(86/132);P>005];但当ICSI组以注射卵子数计算时则两者间有显著性差异[63.0％(87/138)与84.3％(86/102);P<0.05]。优质胚胎率两组间未见显著性差异[54.0％(47/87)与55.8％(48/86);P>0.05]。2.回顾性分析结果显示,IVF组未受精率7.9％(12/154),而ICSI组未见此现象发生。IVF组ICSI组受精率相比,以总卵子数计算未见显著性差异(61.5％比60.1％,P>0.05);当ICSI组以注射卵子数计算时则有显著性差异(61.5％比77.6％,P<0.05)。优质胚胎率两组间未见显著性差异(52.9％比56.1％,P>0.05)。结论:应用胞浆内精子注射有较高的受精率,且不会降低优质胚胎率。将回收卵子同时行IVF与ICSI能避免受精失败的发生。     

Comparative study on the pregnancy outcomes of in vitro fertilization–embryo transfer between long-acting gonadotropin-releasing hormone agonist combined with transvaginal ultrasound-guided cyst aspiration and long-acting gonadotropin-releasing hormone agonist alone

ObjectiveTo retrospectively analyze the effects of long-acting gonadotropin-releasing hormone agonist (GnRH-a) combined with transvaginal ultrasound-guided cyst aspiration on the pregnancy outcomes of in vitro fertilization–embryo transfer (IVF–ET) in the infertile patients with ovarian endometriosis.MethodsThe 134 patients with ovarian endometriosis who underwent GnRH-a combined with transvaginal ultrasound-guided cyst aspiration and IVF–ET were served as experimental group. The 102 patients with ovarian endometriosis who underwent GnRH-a and IVF–ET were served as control group. After treatment, the cyst size, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), number of ovum pick-up, fertility rate, cleavage rate, high-quality embryo rate, implantation rate, clinical pregnancy rate and abortion rate were compared between the two groups.ResultsIn the 134 patients of experimental group, 138 cysts disappeared after GnRH-a combined with three times of transvaginal ultrasound-guided cyst aspiration. In the 102 patients of control group, of the 114 cysts, 34 disappeared after GnRH-a, 67 were decreased and 13 were unchanged. The abortion rate was significantly lower in experimental group than in control group. The level of serum E2 on HCG day, the number of ovarian follicles with 14 mm or more, the number of retrieved oocytes, high-quality embryo rate, implantation rate and clinical pregnancy rate were higher in experimental group than in control group (all P < 0.05).ConclusionGnRH-a combined with transvaginal ultrasound-guided cyst aspiration can obtain better therapeutic effects and pregnancy outcomes in infertile patients with ovarian endometriosis who underwent IVF–ET.     

胚胎移植与囊胚移植的临床结局分析

背景:国内关于卵裂期胚胎移植与囊胚移植的临床比较与分析大样本报道较少见。目的:比较第2,3天卵裂期胚胎移植与第5天囊胚移植的临床结局。方法:选择2008-01/2009-12北京大学深圳医院生殖医学科行体外受精/卵胞浆内单精子显微注射共1612周期,比较第2,3天卵裂期胚胎移植与第5天囊胚移植的临床妊娠率、胚胎种植率、流产率、多胎率、出生婴儿性别比例等差异。结果与结论:第2,3,5天移植组分别195,1162,255周期,临床妊娠率分别为33.33%,38.04%,44.71%,种植率分别为21.37%,24.70%,31.96%;第5天移植组临床妊娠率和种植率均高于第2,3天移植组(P<0.05);第2天移植组宫外孕发生率高于第3天移植组(P<0.05)。3组流产、单卵双胎、多胎、早产及出生婴儿性别比例无差异。说明囊胚移植提高了临床妊娠率和种植率的同时,未增加流产、多胎、早产等风险,对男女性别比例的平衡无负面影响。     

黄体酮阴道缓释凝胶用于体外受精-胚胎移植黄体支持的效果观察及护理

目的 探讨黄体酮阴道缓释凝胶（雪诺同8%）用于体外受精 胚胎移植患者黄体支持的效果及护理要点。 方法 选择2017年1至12月在吉林大学第二医院生殖中心接受长方案促排卵治疗，行新鲜胚胎移植的200例患者作为研究对象，按照不同的黄体支持方案分为对照组和观察组，每组各 100例。对照组肌内注射黄体酮针剂，观察组使用黄体酮阴道缓释凝胶。比较两组患者的临床妊娠率、活产率、自然流产率、生化妊娠率、不良反应率。 结果 观察组临床妊娠率、活产率显著高于对照组（P＜0.05），不良反应率显著低于对照组（P＜005）。两组自然流产率、生化妊娠率比较，差异无统计学意义（P＞0.05）。 结论 黄体酮阴道缓释凝胶用于体外受精 胚胎移植患者黄体支持，能有效提高临床妊娠率和活产率，降低不良反应率。     

新鲜胚胎与冷冻胚胎移植在体外受精周期中疗效比较的Meta分析

背景：胚胎移植的方式主要包括新鲜胚胎移植和冷冻胚胎移植,但两种方法各有优缺点,哪种方法更有利于患者的受孕目前仍存在较大争议。目的：系统评价新鲜胚胎移植与冷冻胚胎移植在体外受精-胚胎移植（IVF）周期中的临床疗效。方法：计算机检索Medline、Cochrane Library、Ovid、EMBASE、中国生物医学、中国期刊全文和万方数据库,以及手工检索国内相关妇产科杂志。检索新鲜胚胎移植与冷冻胚胎移植在IVF周期中的疗效对比的随机对照研究文献,评价指标包括临床妊娠率、持续妊娠率、流产率等。由2名评价者按照纳入与排除标准选择试验,提取资料和评价质量,并采用RevMan 5.2软件进行Meta分析。结果与结论：共纳入随机对照研究3篇,包括633例患者。Meta分析结果显示：冷冻胚胎组在持续妊娠率方面,优于于新鲜胚胎组[OR=0.60,95%CI（0.44,0.84）,P=0.003];在临床妊娠率方面,冷冻胚胎组优于新鲜胚胎组[OR=0.60,95%CI（0.44,0.83）,P=0.002];在流产率方面,2组比较差异无显著性意义[OR=1.23,95%CI（0.60,2.49）,P=0.57]。提示在IVF周期中,冷冻胚胎移植在持续妊娠率及临床妊娠率方面优于新鲜胚胎移植。但受纳入研究样本量及方法学质量限制,尚需开展更多大样本、高质量随机对照试验来增加证据的论证强度。     

阴道超声引导下胚胎移植对反复种植失败患者妊娠结局的影响

目的：探讨阴道超声引导下胚胎移植对反复种植失败（repeated implantation failure，RIF）患者冻融胚胎移植妊娠结局的影响。方法：回顾性分析2017年6月至2019年6月进行体外受精-胚胎移植（in vitro fertilization and embryo transfer，IVF-ET）患者中再次行冻融胚胎囊胚移植48例RIF患者的临床资料，根据胚胎移植时是否使用阴道超声引导分为实验组（24例）和对照组（24例），比较2组间的胚胎种植率、临床妊娠率及流产率。结果：实验组临床妊娠率（37.50%）和胚胎种植率（29.26%）显著高于对照组（29.16%、21.05%），差异有统计学意义（P<0.05）；实验组流产率（11.11%）与对照组（14.28%）相比，差异无统计学意义。结论：采用阴道超声引导下胚胎移植可改善RIF患者的临床妊娠结局。     

玻璃化冷冻对胚胎体内外发育潜能的影响

目的观察新鲜8-细胞胚胎和玻璃化冷冻复苏8-细胞胚胎在囊胚形成率、囊胚孵出率及胚胎种植率、小鼠出生率的差异,探讨玻璃化冷冻对胚胎体内外发育潜能的影响。方法性成熟期雌鼠（〉6～7周龄）106只,取2-细胞胚胎,培养至6～8细胞胚胎时分为新鲜胚胎进行移植（新鲜移植组）和玻璃化冷冻（玻璃化冷冻组）,2周后复苏移植。2组各取50枚移植前胚胎,体外培养48～72h,观察2组胚胎体外培养发育至囊胚及囊胚孵出情况。新鲜胚胎及复苏后的8-细胞胚胎经1～3h培养,选择外形正常胚胎移植于假孕63～67h的受体母鼠的两侧子宫中,妊娠17～20d自然分娩后记录产仔数,比较2组妊娠率、小鼠出生率。结果新鲜移植组囊胚形成率、孵出率、妊娠率、出生率分别为92%,84%,48.93%,13.16%,玻璃化冷冻组囊胚形成率、孵出率、妊娠率、出生率分别为90%,86%,47.06%,12.62%,2组差异均无统计学意义（P〉0.05）。结论玻璃化冷冻复苏对小鼠胚胎体内外发育潜能无明显影响。     

胚胎移植与囊胚移植的临床结局分析

背景：国内关于卵裂期胚胎移植与囊胚移植的临床比较与分析大样本报道较少见。目的：比较第2,3天卵裂期胚胎移植与第5天囊胚移植的临床结局。方法：选择2008-01/2009-12北京大学深圳医院生殖医学科行体外受精/卵胞浆内单精子显微注射共1612周期,比较第2,3天卵裂期胚胎移植与第5天囊胚移植的临床妊娠率、胚胎种植率、流产率、多胎率、出生婴儿性别比例等差异。结果与结论：第2,3,5天移植组分别195,1162,255周期,临床妊娠率分别为33.33%,38.04%,44.71%,种植率分别为21.37%,24.70%,31.96%;第5天移植组临床妊娠率和种植率均高于第2,3天移植组（P〈0.05）;第2天移植组宫外孕发生率高于第3天移植组（P〈0.05）。3组流产、单卵双胎、多胎、早产及出生婴儿性别比例无差异。说明囊胚移植提高了临床妊娠率和种植率的同时,未增加流产、多胎、早产等风险,对男女性别比例的平衡无负面影响。     

精子形态、DNA碎片指数和精浆锌对体外受精-胚胎移植妊娠结局的影响

目的分析精子形态、DNA碎片指数(DFI)和精浆锌对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法选取2015年6月至2019年2月于我院生殖中心行IVF-ET治疗的278例夫妇为研究对象,依据临床妊娠结局将其分为妊娠组(92例)与未妊娠组(186例)。比较两组的一般资料、精液参数及DFI。结果两组的年龄、不育年限、BMI、获卵数、避孕时间、鲜胚移植周期比较,差异无统计学意义(P>0.05)。妊娠组IVF、ICSI周期的精子浓度、前向活动力、精浆锌水平均高于未妊娠组,DFI低于未妊娠组;妊娠组ICSI周期的精子畸形率低于未妊娠组(P<0.05)。结论精子形态、DFI及精浆锌对IVF-ET妊娠结局有明显影响,且DFI可影响精子前向运动,导致精子畸形,影响早期胚胎发育。     

In vitro fertilization. The Scripps Clinic experience

The in vitro fertilization (IVF) program at Scripps Clinic and Research Foundation, La Jolla, California, was started in 1983. In vitro fertilization is now an accepted type of infertility treatment for many couples with a disorder of tubal origin, endometriosis, male-factor infertility, or idiopathic infertility. Successful outcome has depended on the woman's age, the cause of infertility, and the number of embryos transferred. The highest pregnancy rate has been achieved in women under age 35 with tubal-factor infertility and transfer of three or more embryos. During the first year, the program's overall pregnancy rate was 13% (5 pregnancies/38 embryo transfers) and the pregnancy rate for women under age 35 with tubal-factor infertility was 28%. The functioning of an IVF program depends on the availability of a clinical laboratory for daily hormone measurements, ultrasonography for monitoring follicle growth, an operating room that is available any time day or night, and a laboratory equipped for fertilization of retrieved ova and monitoring of embryo development. Clearly, a carefully integrated team of medical care providers is necessary for a program that draws on so many different clinical resources.     

重组人粒细胞集落刺激因子治疗IVF-ET不明原因反复种植失败患者的效果研究

目的探讨重组人粒细胞集落刺激因子(recombinant human granulocyte colony stimulating factor, rh G-CSF)治疗不明原因反复胚胎种植失败(unexplained repeated implantation failure, uRIF)患者的效果及安全性。方法选择2018年1月-2019年4月在我院行第四次冻融胚胎移植的uRIF患者120例,根据药物治疗方法的不同分为观察组和对照组各60例。观察组在解冻移植前1 h皮下注射rh G-CSF 300 U,移植后第3、5日再分别皮下注射rh G-CSF 150 U,同时予常规黄体支持治疗;对照组仅予常规黄体支持治疗。比较两组生化妊娠率、临床妊娠率、胚胎种植率、流产率以及应用安全性。结果观察组生化妊娠率、临床妊娠率及胚胎种植率均高于对照组,差异均有统计学意义(P<0.05或P<0.01),但两组流产率比较差异无统计学意义(P>0.05);观察组仅2例出现轻微发热(<38℃),第2日自行缓解,无其他不良反应。结论 rh G-CSF能够改善uRIF患者再次解冻移植的妊娠结局,且应用安全性较好。     

In vitro fertilization update

Success rates with in vitro fertilization (IVF) continue to improve as we gain insight into optimal culture conditions for gametes and embryos. New procedures such as in vitro egg maturation, preimplantation genetic testing, single embryo transfer, and oocyte freezing hold the promise of reducing the cost, inconvenience, and risks of IVF, as well as preserving future fertility. We provide an overview of the current and experimental assisted reproductive technology techniques.