来源未见原核(0PN)卵裂期胚胎移植的临床分析

目的分析IVF-ET中完全来源0PN卵裂期胚胎新鲜移植周期的妊娠结局,评价0PN卵裂期胚胎临床应用价值。方法回顾性调查2011年8月至2013年11月在安徽省妇幼保健院生殖中心接受IVF-ET治疗中21个完全来源0PN的卵裂期胚胎新鲜移植周期,分析其临床妊娠情况。结果 21个完全来源0PN的卵裂期胚胎新鲜移植周期中临床妊娠6例(9胎),其中3例活产(3男2女),2例流产(3胎),1例异位妊娠。结论 IVF-ET新鲜移植周期中在没有来源2PN正常受精的卵裂期胚胎时,可慎重选择来源0PN的卵裂期胚胎进行胚胎移植。     

玻璃化冻融人胚胎卵裂期与囊胚期移植临床应用的效果比较

目的比较人胚胎卵裂期与囊胚期在玻璃化冻融胚胎移植结局的应用效果。方法回顾性分析2013年度在我院接受冻融卵裂期胚胎移植的267个周期(A组)和2012年11月至2014年5月接受囊胚期移植的91个周期(B组)的相关资料,根据患者年龄、内膜厚度及促排方案、移植优质胚胎数,比较两组之间的临床妊娠率、种植率、流产率。结果B组较A组妊娠率、种植率、流产率妊娠均有显著性差异(65.94%vs40.07%,48.85%vs23.10%,6.67vs14.94%),P0.05。两组间在年龄、内膜厚度及促排方案结果有一致性也有不同性;单胚胎移植,优质胚胎B组较A组有显著性差异(80.0%VS50.0%),卵裂期:ET2枚优胚与ET3枚优胚结局(43.51%VS51.92%)比较无差异性;ET1个优囊较卵裂期ET3个优胚的临床妊娠率(50.0%VS51.92%)有一致性。结论玻璃化冻融胚胎移植,年龄、内膜厚度及促排方案、移植优质胚胎数对妊娠的成功起主要作用,囊胚移植能取得较高的临床妊娠率,移植2枚优质胚胎在卵裂期与囊胚期均能获得较好的临床结局。     

D3卵裂期优质胚胎与非优质胚胎培养形成囊胚率及临床应用价值

目的探讨D3卵裂期非优质胚胎与优质胚胎继续培养形成囊胚率及临床应用价值。方法收集本中心486个体外受精-胚胎移植(IVF-ET)和卵胞浆内单精子注射-胚胎移植(ICSI-ET)治疗周期中受精后第3天(D3)移植、冷冻保存后剩余的404枚优质胚胎,528枚非优质胚胎继续囊胚培养,比较两种胚胎的囊胚形成率。玻璃化冷冻已形成的囊胚,如果患者新鲜周期移植妊娠失败,则在下一周期把囊胚解冻移植,比较两种冻融囊胚的种植率和临床妊娠率。结果 D3卵裂期优质胚胎囊胚形成率为88.37%,非优质胚胎囊胚形成率为42.42%(P0.01);其中优质胚胎的78枚囊胚在下一周期解冻移植,其种植率为42.37%,妊娠率为63.53%;非优质胚胎的64枚囊胚在下一周期解冻移植,其种植率为39.65%,妊娠率为58.78%,两组比较差异没有统计学意义(P0.05)。结论⑴D3优质胚胎继续囊胚培养形成率明显高于非优质胚胎。⑵卵裂期优质胚胎培养形成的囊胚与非优质胚胎形成的囊胚冻融后移植的种植率及临床妊娠率没有明显差异。     

玻璃化冷冻人不同发育时期的胚胎对其发育潜能的影响

目的分析使用玻璃化冷冻法对人D3卵裂期细胞及囊胚进行冷冻,对胚胎发育潜能的影响。方法从2013年3月至2015年12月180周期358枚胚胎行解冻胚胎移植,将胚胎分为卵裂组及囊胚组,统计解冻后存活率,移植后着床率、妊娠率、流产率及多胎妊娠率。结果 D3卵裂组与囊胚组解冻后存活率没有差异,但移植后发育潜能卵裂组明显低于囊胚组。结论冷冻解冻移植囊胚期的胚胎比卵裂期的胚胎更有发育潜能。     

非优质胚胎继续囊胚培养与冻融囊胚移植的临床应用价值

目的探讨将非优质胚胎继续囊胚培养与冻融囊胚移植的临床应用价值。方法收集生殖中心235个体外受精-胚胎移植(IVF-ET)和卵胞浆内单精子注射-胚胎移植(ICSI-ET)治疗周期中受精后第3天(D3)移植、冷冻保存后剩余的1026枚非优质胚胎继续囊胚培养,观察优质囊胚的形成情况,并玻璃化冷冻保存,若患者在新鲜移植周期妊娠失败,则在下一周期把囊胚解冻移植,比较冻融囊胚与同时期冻融卵裂胚的种植率和临床妊娠率。结果 D3非优质胚胎的优质囊胚形成率为36.6%,其中有43名患者的77枚优质囊胚在下一周期解冻移植,胚胎种植率(41.6%)和临床妊娠率(65.1%)显著高于同时期100名患者的202枚卵裂胚解冻后移植的胚胎种植率(25.3%)和临床妊娠率(43.6%)(P0.05),流产率无显著性差异(P0.05)。结论 1继续囊胚培养能有效筛选出非优质胚胎中具有发育潜能的胚胎,提高其利用率;2冻融囊胚移植能提高胚胎种植率和临床妊娠率。     

非优质卵裂胚胎继续培养至囊胚的临床应用研究

目的探讨新鲜IVF/ICSI周期中移植或冷冻后剩余的非优质卵裂期胚胎在体外继续培养至囊胚的临床应用价值。方法将第3天移植或冷冻后剩余的非优质卵裂期胚胎在体外继续培养至第5、6天,选择优质的囊胚进行玻璃化冷冻。冷冻3个月后,当需要时将其解冻后进行胚胎移植,观察统计第5、6天囊胚移植后的妊娠结局。结果 67个解冻周期中共解冻102枚囊胚,复苏率、妊娠率及种植率为99.02%、22.39%和15.84%;其中第5、6天囊胚复苏率、妊娠率和种植率分别为(100%vs98.36%)、(32%vs16.67%)和(21.95%vs11.67%),两者间无统计学差异。结论部分第3天非优质卵裂期胚胎可在体外继续培养至囊胚,从中选择优质囊胚进行冻融胚胎移植,从而提高胚胎的利用率。     

早补救ICSI新鲜周期与复苏周期卵裂期胚胎移植临床结局分析

目的探讨行早补救ICSI助孕治疗患者新鲜周期与复苏周期卵裂期胚胎移植的临床妊娠结局。方法回顾性分析2014年01月至2017年06月期间在我院生殖中心接受治疗的患者,在短时受精失败行早补救ICSI助孕、并行冷冻卵裂期胚胎移植的患者共29个周期,为复苏周期组;与同期行早补救ICSI助孕而移植新鲜卵裂期胚胎的患者共16个周期,为新鲜周期组,比较两组的临床妊娠结局。结果复苏周期的临床妊娠率为41.38%(12/29),胚胎种植率为33.33%(18/54),流产率为16.67%(2/12);新鲜周期的临床妊娠率为43.75%(7/16),胚胎种植率为34.48%(10/29),流产率为14.28%(1/7),两组之间临床妊娠率、种植率及流产率差异均无统计学意义(P0.05)。结论早补救ICSI助孕治疗患者行新鲜周期与复苏周期的卵裂期胚胎均可获得较好的临床妊娠结局,早补救ICSI不失为一种有效的辅助生殖补救措施,改善了部分患者临床治疗结局。     

移植不同阶段冻融胚胎对异位妊娠风险的影响

目的比较冻融移植周期中囊胚期移植与卵裂期移植的异位妊娠风险。方法回顾性分析2013年1月至2014年9月期间,于解放军第一七四医院生殖中心实施冻融囊胚复苏移植及卵裂期胚胎复苏移植,并移植2枚复苏胚胎的患者的妊娠结局。结果冻融胚胎复苏移植2228周期中,共获得临床妊娠共1079例。在获得临床妊娠的患者中,囊胚期移植与卵裂期移植相比,年龄、移植周期数、移植深度、内膜厚度以及内膜类型,无统计学差异(P0.05),而异位妊娠率显著下降(0.8%vs 3.4%,P0.01)。通过多因素逻辑回归模型校正内膜因素的影响后,囊胚移植相对于卵裂期移植发生异位妊娠的风险比为0.204(0.072-0.578)。结论在冷冻复苏周期中行囊胚移植有利于减少异位妊娠率。     

卵裂期与囊胚期胚胎移植异位妊娠率的比较

目的 探讨囊胚期胚胎移植是否较卵裂期胚胎移植降低患者异位妊娠的发生率。方法 回顾性分析2013年1月至2015年8月在本生殖中心进行移植并获得妊娠的3962个周期,比较D3卵裂胚胎移植与D5/6囊胚移植两组的异位妊娠率。结果新鲜周期囊胚移植异位妊娠率低于卵裂期移植但差异不显著(3.0vs1.9,P=0.127);解冻周期囊胚移植异位妊娠率显著低于卵裂期移植(6.8vs2.1,P0.05)。结论 囊胚移植较卵裂期移植可降低异位妊娠的发生率,由其是解冻周期。对于有异位妊娠高风险的患者可以考虑囊胚移植。     

常规IVF受精失败补救ICSI后行冻融胚胎移植的临床价值

目的探讨冻融胚胎移植在常规体外受精(IVF)失败后补救卵胞浆内单精子注射(L-ICSI)中的应用价值。方法在12个常规体外受精失败周期中应用ICSI对未受精的MⅡ期卵子进行显微授精,将获得的优质胚胎进行冷冻,再择期行冻融胚胎移植。结果对93个未受精的MⅡ卵子接受L-ICSI,受精63枚,受精率为67.7%(63/93),异常受精3枚(2枚1PN,1枚3PN),57个正常受精卵发生卵裂,卵裂率为95.0%(57/60),优质胚胎率为43.9%(25/57),10例患者冷冻胚胎25枚,其中4例采用程序化冷冻,6例采用玻璃化冷冻。9个患者行冻融胚胎移植,共移植胚胎18枚(其中解冻后胚胎碎裂死亡5枚),其中1个周期因冻融后2个胚胎碎裂放弃移植,2例获得临床妊娠,1例分娩出正常婴儿,1例正在妊娠中,临床妊娠率为22.2%。结论 ICSI可使常规体外受精失败的卵子再受精,冻融胚胎移植可以解决胚胎与子宫内膜不同步的问题,获得相对满意的临床结局,具有一定的应用价值。     

One versus two embryo transfer after IVF and ICSI: a randomized study

BACKGROUND: The main reason for adverse treatment outcome in assisted reproduction is the high rate of multiple pregnancies. The only strategy to avoid dizygotic twins is to transfer one embryo at a time. METHODS: A total of 144 women, who had had at least four good quality embryos available after IVF/intracytoplasmic sperm injection (ICSI) and who had no more than one previous failed treatment cycle, were randomized to have either one or two embryos transferred. The treatment outcomes including those after frozen embryo transfer were compared between these groups. RESULTS: The clinical pregnancy rate per transfer was 32.4% in the one embryo transfer group and 47.1% in the two embryo transfer group, the difference being not significant. Eleven twin deliveries (n = 39) occurred in the two embryo transfer group and there was one pair of monozygotic twins in the one embryo transfer group. The cumulative pregnancy rate per patient after transfer of fresh and frozen embryos was 47.3% in the one embryo transfer group and 58.6% in the two embryo transfer group. CONCLUSIONS: Our results indicate that among women who have good quality embryos in their first IVF/ICSI, good treatment results can be achieved. They support the idea of changing embryo transfer policy towards one embryo transfer without any remarkable decrease in the success rate, while dizygotic twins can be avoided.     

高龄妇女新鲜胚胎和冻融胚胎移植的结局比较

目的探讨高龄妇女接受新鲜胚胎和冻融胚胎移植后的结局。方法对2008年1月～2010年12月期间在我院接受体外受精-胚胎移植和玻璃化冻融胚胎移植的36岁以上的高龄妇女的临床资料进行回顾性分析。结果新鲜胚胎移植306例,383个周期,90个周期获得妊娠,妊娠率23.5%,无畸形胎儿;玻璃化冻融胚胎移植75例,94个周期,27个周期获得妊娠,妊娠率28.72%,1例畸胎（脑积水）,行中孕引产。两种胚胎移植的妊娠率、多胎率、胚胎种植率、早期流产率、异位妊娠率等比较,差异均无统计学意义（P〉0.05）。结论高龄妇女接受新鲜胚胎移植和冻融胚胎移植的妊娠率、多胎率、胚胎种植率、早期流产率、异位妊娠率无显著性差异。由于高龄妇女卵巢和内膜功能下降,建议应在有限的时间内增加胚胎移植的次数来提高累计妊娠率。     

IVF获卵数、全胚冷冻与体外受精胚胎移植妊娠结局的关系

目的探讨控制超排卵（COH）中获卵数对体外受精一胚胎移植（IVF—ET）妊娠结局的影响,及为避免重度OHSS全胚冷冻的效果。方法接受常规IVF助孕治疗的不孕症患者358例（除外ICSI,Half—ICSI,Re—ICSI）。根据获卵数不同分为3组,其中获卵数1～10者122例（I组）,获卵数11～20者183例（II组）,获卵数〉20者53例（Ⅲ组）;358例中发生OHSS48例全胚冷冻,其中I组无全胚冷冻,Ⅱ组全胚冷冻28例,Ⅲ组全胚冷冻20例。结果全胚冷冻组与新鲜移植组比较：年龄及优胚率无明显差异,着床率及临床妊娠率无明显差异;新鲜移植第Ⅲ组着床率及临床妊娠率低于全胚冷冻第Ⅲ组,差异有显著性。结论OHSS时全胚冷冻保证了妊娠结局,尤其对获卵数〉20的患者有利。     

Turner's syndrome and pregnancies after oocyte donation

A total of 20 clinical pregnancies was achieved among 18 women with Turner's syndrome who were treated in an oocyte donation programme. The oocytes were donated by voluntary unpaid donors. A mean of 1.8 embryos per transfer was given to each recipient by way of 28 fresh and 25 frozen embryo transfers. With fresh and frozen embryos, 13 and seven pregnancies respectively were achieved. The clinical pregnancy rate per fresh embryo transfer was 46%, and the implantation rate 30%, being similar to the corresponding rates among our oocyte recipients with primary ovarian failure in general. The corresponding rates with frozen embryos were 28 and 19%. Of these pregnancies, 40% ended in miscarriage. This high rate may be explained by uterine factors. Six women were hypertensive during pregnancy, a rate comparable with that in other oocyte donation pregnancies. All these women delivered by Caesarean section. Pregnancy and implantation rates after oocyte donation were high in women with Turner's syndrome, but the risk of cardiovascular and other complications is high. Careful assessment before and during follow-up of pregnancy are important. Transfer of only one embryo at a time to avoid the additional complications caused by twin pregnancy is recommended.     

The role of the number of replaced embryos on intracytoplasmic sperm injection outcome in women over the age of 40

In order to examine if the transfer of more than three embryos has any beneficial effect on the outcome of intracytoplasmic sperm injection (ICSI) cycles in women aged > 40 years, a retrospective analysis was made of all the ICSI cycles which were performed in this age group from 1 October 1991 to 31 December 1995. A total of 525 cycles was performed in 321 patients. In 413 cycles, at least one normally fertilized embryo was available for transfer. In 271 cycles, one to three embryos were replaced while in the remaining 142 cycles at least four embryos were replaced. There was no difference in implantation rate (number of gestational sacs/number of embryos transferred), after the transfer of one to three embryos (5.2%), compared with the transfer of at least four embryos (5.1%). The pregnancy rate/embryo transfer and the clinical pregnancy rate/embryo transfer were, however, higher when at least four embryos were replaced than was the case with one to three embryos (27.5 versus 11.8%, P < 0.0001 and 20.42 versus 9.96%, P < 0.005, respectively). There were no statistically significant differences in the delivery rates, multiple pregnancy rates or spontaneous abortion rates. The pregnancy rate and the clinical pregnancy rate after ICSI in women > or = 40 years of age are related to the number of embryos replaced.      

影响冻融胚胎临床结局的因素分析

目的探讨影响冻融胚胎移植结局的相关因素。方法收集我中心2009年570个行冻融胚胎移植周期,回顾性分析患者年龄,移植冻融胚胎质量及数量,内膜厚度对临床妊娠率、种植率、多胎率的影响。结果 Logistic回归分析表明:女方年龄、移植数、移植优质胚胎数与临床妊娠显著相关(P<0.01);多胎与女方年龄和移植数相关(P<0.01;P<0.05)。年龄<35岁的妊娠率(49.4%)明显高于≥35岁的妊娠率(37.9%)(P<0.05);移植2个胚胎的临床妊娠率(49.3%),明显高于移植1个胚胎的临床妊娠率(15.4%)(P<0.05),但与移植3个胚胎的临床妊娠率(50.0%)无差异(P>0.05);移植至少1个优胚组妊娠率(58.0%)较无优胚移植组临床妊娠率(37.5%)显著高(P<0.01)。结论女方年龄及移植的胚胎质量是影响移植后妊娠结局的关键因素。     

胚胎碎片对妊娠临床结局及去除后对胚胎发育的影晌

目的观察胚胎碎片对胚胎移植后的临床结局的影响,以及去除碎片对含碎片的胚胎发育影响。方法回顾性分析2012年新鲜IVF周期移植至少一个≥10％碎片的胚胎与移植完全无碎片胚胎临床结局,及2012年3月～5月IVF周期患者O／1PN优质胚胎,观察胚胎碎片去除组、胚胎碎片组及无碎片组的胚胎发育情况。结果含胚胎碎片组的临床妊娠率及种植率显著低于无碎片组,差异有显著性意义;去除碎片组与未去除碎片组的囊胚形成率与无碎片组,差异无显著性意义。结论胚胎碎片影响胚胎的种植;去除胚胎碎片不能显著改善胚胎的发育潜能。     

113例全胚胎冷冻患者首次冻融胚胎移植的临床分析

目的探讨冻融胚胎移植(frozen-thawed embryo transfer,FET)作为首次移植的临床结局,比较其与新鲜胚胎移植的临床妊娠结局。方法回顾性分析珠海市妇幼保健院生殖中心2010年1月至12月接受人类辅助生殖技术(assis-ted reproductive technology,ART)的共902例患者的临床资料。其中,冻融胚胎移植作为首次移植113例,按全胚胎冷冻的原因不同分为5组,即卵巢过度刺激综合征(OHSS)组、孕酮升高组、雌二醇升高组、胚胎发育迟缓组、其他特殊原因组;同期新鲜胚胎移植789例,为对照组。结果 FET组与对照组相比,无论在不孕原因、获卵数、冷冻胚胎数、移植胚胎数、流产率的差异均无显著的差异,而两组患者临床妊娠率(P<0.05)有统计学差异,但FET各组间存在差异。结论不同因素所致FET的临床妊娠结局存在一定差异,新鲜胚胎移植的条件不适宜时,患者是否适合FET应综合各方面情况来加以考虑,以获得最优的ART妊娠结局。     

促排卵移植周期中不同卵裂球数目优势胚胎移植结局的比较

目的探讨体外受精-胚胎移植周期中移植不同卵裂球数目的优势胚胎对妊娠结局的影响。方法对我中心2008年1月-2009年10月270例来曲唑促排卵方案第三天移植的胚胎进行回顾性分析,根据不同卵裂球数目分为4组：至少一个优势胚胎8细胞组（A组）,至少一个优势胚胎7细胞组（B组）,至少一个优势胚胎6细胞组（C组）,小于6细胞组（包括4细胞和5细胞）（D组）计算各组移植后临床妊娠率、种植率,流产率。结果优势胚胎为8细胞的妊娠率和种植率最高（37.5%,19.9%）,其次是7细胞组（25%,15.9%）和6细胞组（23.8%,12.5%）,4细胞和5细胞最低（13.3%,12.1%）,各组具有统计学差异（P〈0.05）。各组流产率无显著统计学差异（P〉0.05）。结论第三天移植优势卵裂球8细胞胚胎获得更高的临床效果,细胞数目少的胚胎仍具有一定的发育潜能,不能轻易丢弃。     

Resumption of mitosis during post-thaw culture: a key parameter in selecting the right embryos for transfer

This retrospective study of 701 thaw cycles analysed the clinical importance of whether or not embryos resumed mitosis during 24 h of post-thaw culture. A total of 3360 frozen embryos were thawed; 1922 embryos survived the freeze-thaw procedure with at least one intact blastomere and were then cultured for 24 h before transfer. All transfers were registered into either the 'cleaved embryo group' (n = 459), which was defined as transfers where at least one of the transferred embryos cleaved during the post-thaw culture period, or the 'non-cleaved embryo group' (n = 153), where none of the transferred embryos cleaved during the post-thaw culture period. A total of 1408 thawed embryos were transferred in 612 cycles; 459 embryo transfers were in the cleaved embryo group, resulting in an implantation rate of 10%, significantly higher than the 4% in the non-cleaved embryo group (P = 0.0003). A total of 130 pregnancies (28% per transfer) were obtained in the cleaved embryo group which was significantly higher than the 17 pregnancies (11% per transfer) obtained in the non-cleaved embryo group (P = 0.0001). However, the average number of transferred embryos was significantly higher in the cleaved embryo group (2.46 +/- 0.03) compared to the non-cleaved embryo group (1.82 +/- 0.07). No difference was found in the age of the women between the two groups. When analysing transfers where all transferred embryos had cleaved during the post-thaw culture period the clinical pregnancy rate increased significantly from 13% transferring two embryos to 36% transferring three embryos (P = 0.0136). In this latter subgroup an implantation rate as high as 17% was obtained. The overall multiple pregnancy rate was 16%. The multiple pregnancy rate was 19% in the cleaved embryo group. In conclusion, 24 h post-thaw culture may allow a better selection of the embryos and thereby we may be able to increase the implantation and pregnancy rates. This may enable us further to reduce the number of embryos transferred.