两种不同胚胎移植管在IVF-ET中的临床应用分析

目的:分析Frydman移植管和PCC移植管在体外受精-胚胎移植(IVF-ET)中的临床效果。方法:回顾性分析2018年1~12月我院IVF-ET治疗中由同一医生完成的949例新鲜胚胎移植周期,根据移植管类型分为两组:Frydman组481例周期(采用进口移植管Frydman),PCC组468例周期(采用国产移植管PCC),分析两组妊娠结局、血染程度、血染位置、装载胚胎耗时、外导管置管困难率和困难移植率。结果:①两组胚胎着床率、临床妊娠率、异位妊娠率、继续妊娠率差异均无统计学意义(P>0.05)。②PCC组无血染率(84.83%)高于Frydman组(63.83%),轻度、中重度血染率和外导管血染率低于Frydman组,差异有统计学意义(P<0.05);两组内导管血染率和内外导管血染率比较,差异无统计学意义(P>0.05)。③两组胚胎装载耗时、困难移植率比较,差异无统计学意义(P>0.05);PCC组外导管置管困难率(36.75%)低于Frydman组(78.38%),差异有统计学意义(P<0.05)。结论:IVF-ET中选择不同胚胎移植管妊娠结局无差异,但国产胚胎移植管PCC有降低血染程度和外导管置管困难率的优点,具有保护子宫颈组织的作用,临床适用性较好。     

胚胎移植技术对体外受精-胚胎移植妊娠结局的影响

目的:评价胚胎移植的难易程度、出血、移植管胚胎遗留对体外受精.胚胎移植(IVF-ET)妊娠结局的影响.方法:回顾性分析我院生殖中心自2001年3月至2005年12月620个IVF-ET周期的胚胎移植技术与其临床结局的关系.结果:困难移植组的临床妊娠率(20.00%)和胚胎种植率(10.29%)低于容易移植组32.79%和15.96%(P＜0.05).移植管出血组的临床妊娠率(19.23%)低于无出血组32.57%(P＜0.05);但胚胎种植率两组分别为11.33%和15.77%,差异无统计学意义.移植管胚胎遗留对临床妊娠率(28.00%与31.60%)和胚胎种植率(14.67%与15.42%)均无明显的影响.结论:胚胎移植过程中出现的困难胚胎移植和出血,将会影响IVF-ET的临床妊娠结局,因此移植过程中应尽量避免.     

胚胎移植气液滴距子宫基底距离和妊娠率之间的关系

目的:研究胚胎移植时气液滴距子宫基底距离和妊娠率之间的关系。方法:回顾性研究南方医院妇产科生殖医学中心2005.01-2006.09间超声引导下取卵周期胚胎移植者610例。通过腹部B超测量移植内管尖距宫底距离及移植时推出气液滴距宫底距离,分析各组间妊娠率的关系及与异常妊娠的关系。结果:不同胚胎移植内管尖距宫腔基底距离(transfer distance from the fundus,TDF)之间的妊娠率无显著差异,>2cm组妊娠率最高,<1cm组最低,但2cm组早期自然流产率较高。不同气液滴到宫底距离与妊娠率无关。其中2cm组妊娠率最高(61.1%),<1cm组妊娠率最低(42.9%),而0距离组自然流产率最高(20%)。气液滴-移植内管尖距离3组妊娠率无显著差异。结论:气液滴及移植内管尖位置与妊娠率没有显著性差异。     

超声引导下冻融胚胎移植的临床价值

目的 探讨超声引导下在冻融胚胎移植周期中对妊娠率和种植率的影响.方法 将2004-03-2005-10在河北医科大学第二医院生殖中心接受冻融胚胎移植的85例患者(86个周期)随机分组:超声引导下移植组42个周期(超声组)和常规移植组44个周期(对照组),比较两组妊娠率和种植率.同时超声组根据移植时移植泡距宫底的距离分为3组:A组＜10mm、B组10～15mm和C组＞15mm,并比较各组间的妊娠率.结果 超声组妊娠率、种植率分别为33.3%、15.8%,对照组分别为15.9%、5.6%,两组比较差异均有统计学意义(P＜0.05);B组妊娠率为60.0%,显著高于A组和C组(P＜0.05).结论 超声引导下胚胎移植可提高冻融胚胎周期妊娠率,并且胚胎放置在宫腔内的位置可能与妊娠率有关.     

胚胎移植技术对IVF临床妊娠率的影响

目的 :研究胚胎移植技术对IVF临床妊娠率的影响。方法 :分析IVF ET 373例移植管是否沾血 ,移植管放置的难易度及移植持续时间。结果 :移植管沾血组的临床妊娠率、胚胎种植率明显低于未沾血组 ,胚胎残留率高于未沾血组 ;插管顺利组的临床妊娠率明显高于插管有阻力组、困难组及极困难组 ;移植持续 5～ 15min组的临床妊娠率与 <5min组无明显差异。结论 :胚胎移植时出血、插管困难降低了IVF的临床妊娠率。     

影响冷冻胚胎移植妊娠率相关因素分析

目的: 探讨影响冷冻胚胎移植妊娠率的相关因素。 方法: 对129个接受冷冻胚胎移植患者的临床资料进行回顾性分析。结果: 129个冷冻胚胎移植周期,临床妊娠率27.1%,胚胎种植率12.8%;三种不同移植方案、常规体外受精(IVF)、单精子卵母细胞浆内注射(ICSI)所冻存的胚胎移植临床妊娠率无显著性差异(P>0.05)。<30、30~34、35~44岁三个年龄组胚胎种植率有显著差异(P<0.05);临床妊娠率以30~34岁组为最高(38.6%),35~44岁组明显下降(13.6%),三年龄组比较有显著性差异(P<0.05)。移植≥2个胚胎的子宫内膜厚度、平均移植胚胎数、累积胚胎评分、累积胚胎评分/胚胎移植数以及至少移植有1个4-细胞I级胚胎者,妊娠组与非妊娠组均有显著性差异(P<0.01)。 结论:患者的年龄、子宫内膜厚度、移植胚胎数目、胚胎形态及生长速率是影响冷冻胚胎移植妊娠率的重要因素。     

胚胎移植位置对体外受精-胚胎移植结局的影响

目的探讨体外受精-胚胎移植（IVF-ET）中,在B超引导下将胚胎移植到子宫腔内的不同位置对妊娠率及胚胎种植率的影响。方法回顾性分析接受IVF-ET治疗的98例输卵管因素不孕患者（共108个周期）的临床资料,根据胚胎移植位置的不同分为两组：A组,胚胎移植到距宫底≥5～〈10mm,共51例患者,56个周期;B组,胚胎移植到距宫底≥10～≤15mm,共47例患者,52个周期。比较两组患者的临床妊娠率、胚胎种植率、异位妊娠率、多胎妊娠率及流产率。结果A组56个周期中,有14个周期妊娠,临床妊娠率为25％,移植胚胎121个,种植17个,胚胎种植率为14％;B组52个周期中,有23个周期妊娠,临床妊娠率为44％,移植胚胎115个,种植28个,胚胎种植率为24％。B组临床妊娠率和胚胎种植率显著高于A组,两组分别比较,差异均有统计学意义（P〈0．05）。两组的多胎妊娠率、异位妊娠率和流产率分别比较,差异均无统计学意义（P〉0．05）。结论在IVF-ET中,胚胎移植位置的不同可影响临床妊娠率和胚胎种植率。     

两种不同胚胎装载技术对体外受精-胚胎移植及冻融胚胎移植临床结局的影响

目的探讨两种不同胚胎装载技术对体外受精-胚胎移植(IVF-ET)和冻融胚胎移植(FET)临床妊娠率及胚胎种植率的影响。方法回顾性分析了543个新鲜胚胎移植周期及658个FET周期。根据移植时胚胎装载方法分为A组(含胚培养液体积周围空气体积)和B组(含胚培养液体积周围空气体积)。比较两种胚胎装载方法对妊娠结局的影响。结果新鲜周期中,B组的临床妊娠率(64.52%)显著高于A组(54.62%)(P0.05),种植率组间虽无统计学差异(P0.05),但B组明显高于A组。FET周期中卵裂胚移植B组的临床妊娠率(49.43%)明显高于A组(38.24%),但没有统计学差异(P0.05),B组(34.62%)的种植率显著高于A组(23.61%)(P0.05)。囊胚移植两组的妊娠率和种植率均没有统计学差异(P0.05),但B组比A组有增高的趋势。结论胚胎移植时含胚培养液体积周围空气体积会显著提高IVF-ET和FET的临床妊娠率和种植率。     

全胚冷冻再行解冻胚胎移植周期的临床结局分析

目的:探讨新鲜移植周期与冻融胚胎移植(FET)周期妊娠结局的差异。方法:回顾性分析本中心刺激周期行新鲜胚移植(190例)和全部胚胎冷冻后再行FET(97例)周期的临床妊娠率、种植率以及流产率。结果:190例刺激周期新鲜胚胎种植后的妊娠率、种植率、流产率分别为47.4%(90/190)、30.2%(103/341)、10.0%(9/90),97例全部胚胎冷冻后行FET后的妊娠率、种植率、流产率分别为60.8%(59/97)、47.0%(86/183)、10.2%(6/59),组间妊娠率与种植率均有统计学差异(P<0.05),流产率无统计学差异(P>0.05)。结论:对于有OHSS风险等不适宜进行新鲜胚胎移植的患者,选择全部胚胎冷冻并择期进行FET,并不降低胚胎种植率和临床妊娠率,从而预防迟发型OHSS的发生,可获得更为理想的妊娠结局。     

自然周期冻融胚胎移植日雌二醇水平对妊娠结局的影响

目的探讨冻融胚胎移植时自然周期内膜准备中胚胎移植日雌二醇(E2)水平对妊娠结局的影响。方法选择2010年9月至2011年10月在沈阳市妇婴医院生殖中心进行冻融胚胎移植周期中,以自然周期进行内膜准备的患者110例,进行130个周期冻融胚胎移植。按移植日雌二醇水平分为4组:A组:E2≤183.5pmol/L14周期;B组:E2>183.5pmol/L,≤367.0pmol/L34周期;C组:E2>367.0pmol/L,≤734.0pmol/L74周期;D组:E2>734.0pmol/L8周期。对各组的年龄、子宫内膜厚度、移植胚胎数、临床妊娠率、胚胎种植率及流产率进行比较。结果各组年龄、子宫内膜厚度、移植胚胎数及流产率比较差异均无统计学意义。C组临床妊娠率和种植率分别为62.2%和30.9%,明显高于A组(42.9%,23.5%)和B组(52.9%,28.6%),P<0.05。B组临床妊娠率和种植率与A组比较有增高趋势,但差异无统计学意义,P>0.05。D组临床妊娠率为25.0%(2/8),胚胎种植率为10.0%(2/20)。D组因例数较少未进行统计学比较。结论在冻融胚胎移植周期中,以自然周期进行内膜准备时,胚胎移植日雌二醇水平过低或过高都影响临床妊娠率及胚胎种植率。     

Influence of embryo transfer depth on in vitro fertilization and embryo transfer outcomes

OBJECTIVE: To investigate the influence of transfer distance from the fundus (TDF) on clinical pregnancy rate (PR) and ectopic pregnancy rate. DESIGN: Retrospective cohort. Between January 2000 and December 2001, 699 ultrasound (US)-guided embryo transfers were conducted. Mock transfer was performed to measure uterine cavity depth 1 month before treatment. Cavity depth was measured by abdominal US before the transfer, from the vaginal stripe to the fundus. Transfers were performed with a Wallace embryo transfer catheter (Cooper Surgical, Shelton, CT) using US and physician's judgment of cavity depth. Transfer distance from the fundus was calculated by subtracting the depth of catheter insertion from the cavity depth, as determined by US or by mock transfer. Statistical analyses were performed by building a multivariable logistic regression model to calculate odds ratios and 95% confidence intervals (CI). SETTING: Women aged 23 to 43 years who are in a university-affiliated, community-based IVF program in Springfield, Massachusetts. PATIENT(S): All patients enrolled in IVF program undergoing embryo transfer. INTERVENTION(S): No patient received any additional procedure or intervention. All of the measurements obtained with the embryo catheter and the transvaginal ultrasound were part of the program's protocol for the embryo transfer. MAIN OUTCOME MEASURE(S): Odds ratio examining relationship between embryo transfer depth and PR.Clinical, implantation, and ectopic PR were 37%, 20%, and 2.1%. Cavity depth by US differed from cavity depth by mock by at least 10 mm in >30% of cases. The TDF by US was highly predictive of PR; TDF by mock was not predictive of PR. Increasing the TDF by US resulted in significantly increased PR as well as lower ectopic rates. Using regression analysis, the odds ratio for TDF by US was 1.11 (95% CI: 1.07-1.14). This suggests that for every additional millimeter embryos are deposited away from the fundus, the odds of clinical pregnancy increased by 11%. CONCLUSION(S): After controlling for potential confounders, the clinical PR is significantly influenced by the transfer distance from the fundus. Cavity depth by US is clinically useful to determine the depth beyond which catheter insertion should not occur.     

Validity of trans-rectal ultrasound-guided embryo transfer against retroflexed uterus

Background:  Embryo transfer is one of the most critical steps affecting the success of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer. It has been reported that uterine contraction caused by touching the uterine fundus at the time of embryo transfer decreased the pregnancy rate. It was demonstrated that there is a significant rise in the pregnancy rate by adequate positioning of embryos. Transabdominal ultrasound-guided embryo transfer has been reported to improve the pregnancy rate compared with the clinical touch method. The improvement of the pregnancy rate under ultrasound guidance can be attributed to the accurate positioning of the embryos aided by good visualization without touching the uterine fundus. However, sometimes difficulties are encountered when visualizing the tip of the catheter in cases where the patient has a retroflexed uterus.
Methods:  In the present study, we investigated the difference in the pregnancy rates and in the implantation rates between transabdominal ultrasound-guided group and trans-rectal ultrasound-guided group in retroflexed cases.
Results and Conclusion:  We found that the pregnancy rate and the implantation rate were higher among the trans-rectal group compared with the transabdominal group in retroflexed cases. The difference between the two groups was statistically significant. (Reprod Med Biol 2003; 2 : 159–163)     

The influence of the depth of embryo transfer into the uterine cavity on implantation rate

ObjectiveTo assess the effect of the depth of embryo transfer replacement on implantation and clinical pregnancy rates in intracytoplasmic sperm injection cycles.Materials and methodsThis study was conducted on 90 consecutive patients. All patients underwent a standard down regulation protocol for ovarian stimulation. Oocytes retrieval was performed at 36h after HCG administration. Embryo transfer took place 2–4days after oocyte retrieval. The patients were grouped according to the distance between the tip of the catheter and the uterine fundus at transfer (group I <0.75cm, group II 0.75–<1.5cm, group III 1.5–2cm).ResultsImplantation and clinical pregnancy rates varied significantly between group I and other groups: 10.3% and 13.3%, respectively, in group I; 26.7% and 53.3%, respectively, in group II; 27.8% and 53.3%, respectively, in group III.ConclusionThe depth of embryo replacement inside the uterine cavity may influence implantation rates and should be considered as an important factor to improve the success of implantation and pregnancy rates.     

Antibubble trajectory during embryo transfers in donor egg IVF does not predict success

Transient motion of embryo transfer-associated antibubbles was observed. This prospective study was performed to determine if this antibubble movement can predict a successful outcome. Transabdominal ultrasound-guided embryo transfers were performed in 187 recipients receiving identical hormone replacement therapy. All embryo transfers were performed by the first author, using the Sureview embryo transfer catheter, in 30 mul of culture media. Observation was made of the catheter placement in relation to the endometrial surface and uterine fundus during embryo transfer. Ultrasound-guided tracking of antibubble within the uterine cavity was done immediately after the piston was depressed at the time of embryo deposition. The antibubble movement was upwards (group A) in 104 embryo transfers and downwards (group B) in 83 transfers. No movement of embryo-associated air out of the uterine cavity, either into the cervix or the intramural portion of the Fallopian tube, was observed. The clinical pregnancy rate was similar in both groups: 47.12% in group A versus 45.78% in group B. The total implantation rate/embryo transferred was 19.34% in group A compared with 20.07% in group B. The movement of the embryo transfer-associated antibubble is unlikely to be a factor in predicting success in donor egg IVF cycles.     

Effect of blood and mucus on the success rates of embryo transfers

Objectives

To provide information about the effects of blood and mucus on the embryo transfer (ET) catheters after transfer on embryo transfer outcomes.

Study design

Retrospective analysis of 8311 ultrasound-guided embryo transfers performed in a single center. In 6897 cases (82.9%), there were no blood on the catheter after ET, 1168 transfers were associated with mild blood (14.1%), 33 transfers with moderate blood (0.4%) and 213 transfers with severe blood (2.6%). A total of 6162 transfer catheters were free of mucus (74.8%), whereas mucus was detected on 2081 catheters (25.2%).

Results

The implantation rate (IR) was highest in the group with no blood on the transfer catheter, and lowest in the group with severe blood on the catheter. The clinical pregnancy rate (CPR) was lowest in the group with severe blood on the catheter. The presence of mucus on the catheter was found to have no effect on IR, CPR, biochemical pregnancy rates, miscarriage rates and live birth rates.

Conclusions

This study showed decreased IR, CPR and live birth rates in ETs associated with blood on the catheter. Mucus on the catheter appeared to be a simple contamination in this study and pregnancy rates remained unaffected.     

The impact of the depth of embryo replacement on IVF outcome

Purpose: To evaluate the effect of the depth of embryo transfer replacement on clinical pregnancy rate. Methods: Data from a total of 104 consecutive embryo transfers performed on 104 womenn aged 26–37 years were prospectively collected for this study. All patients underwent a standard down regulation protocol for ovarian stimulation. Oocytes retrieval were performed at 36 h after hCG administration. Embryo transfer took place at 48 h after insemination. The patients were matched in two groups according to the distance between the tip of the catheter and the uterine fundus at transfer (group A > 10 < 15 mm and group B ≤ 10 mm). The same method of loading embryos into the embryo transfer catheter was used. Results: Clinical pregnancy rates varied significantly (p ≤ 0.05) between the two groups: 27.7% in group A and 14% in group B. The number and quality of embryos transferred did not differ between the groups. Conclusions: The results suggest that the depth of embryo replacement may be an important variable in embryo transfer technique.     

Impact of transabdominal ultrasound guidance on performance and outcome of transcervical uterine embryo transfer

Purpose : To determine the impact of transabdominal ultrasound guidance on embryo transfer during IVF therapy. Methods : Retrospective analysis of 823 consecutive embryo transfers. Three hundred and sixty-seven procedures performed with transabdominal ultrasound guidance were compared to 456 cases performed with the clinical touch method. Results : Ultrasound-guided embryo transfer yielded higher, but not statistically significant, clinical pregnancy (48% vs. 44%) and implantation rates (22% vs. 20%). The incidence of multiple pregnancies, ectopic and multiple pregnancy rates were similar. The frequency of negative factors typically associated with difficult transfers, such as requirement of use of tenaculum, and presence of blood or mucus in the catheter tip, were significantly lower in the ultrasound-guided group in comparison with the clinical touch group. Ultrasound-guided embryo transfer was associated with a significantly increased easiness of transfer performance; 95% of the transfers were rated as very easy in the ultrasound-guidance group compared to 87% in the clinical touch group. The use of a soft pass catheter was the only variable independently and significantly associated with pregnancy success (odds ratio = 2.74). Conclusion(s) : Ultrasound-guidance facilitates embryo transfer and in combination with the use of a soft catheter should be implemented to optimize embryo transfer results.     

The effect of retained embryos on pregnancy outcome in an in vitro fertilization and embryo transfer program

OBJECTIVE: The purpose of this study was to determine the incidence of retained embryos and its impact on pregnancy outcome in the absence of known risk factors like blood and mucus in the transfer catheter. The factors that could be associated with embryo retention were also investigated. STUDY DESIGN: The results of all embryo transfer procedures performed at Ankara IVF Center between January 2003 and December 2005 were analyzed retrospectively. Three hundred and five embryo transfers, in which the transfer catheter was contaminated with blood or mucus, were excluded and the remaining 1,454 embryo transfers, with clean catheter, were enrolled into the study. Both fresh (n=1,422) and frozen (n=32) embryo transfers were included. RESULTS: The overall incidence of retained embryos during study period was 2.8% (41/1,454) following a clean initial embryo transfer. The mean age of the female partner, mean number of retrieved oocytes, MII oocytes, fertilized oocytes and the embryos transferred were similar in patients with and without retained embryos. The 1,454 embryo transfers performed during the study period resulted in 712 pregnancies (49%), of which 639 proved to be clinical pregnancies with a rate of 44%. The implantation rate was 22.8%. Pregnancy outcomes including positive beta-hCG (58.5% versus 48.7%), biochemical (4.7% versus 5.1%) and clinical pregnancy rates (53.6% versus 43.6%), implantation rate (24% versus 22.7%) and multiple pregnancy rate (36.3% versus 44.7%) were not significantly different between patients with and without retained embryos. An influence of individual physicians and embryologists on the frequency of retained embryos was not detected. The type of embryo transfer catheter used did not show any difference in terms of embryo retention. The cleavage stages of embryos were not different between groups. Although it was not statistically significant, the number of embryos transferred appeared to be a potentially confounding factor for retained embryos (p=0.053) and it might be significant in a slightly larger sample. When transfer of one or two embryos was compared to three or more embryos, the likelihood of retained embryos increased from 1.2% (4/321) to 3.2% (37/1,133). CONCLUSION: Retained embryos in the transfer catheter and immediate retransfer of them have no adverse impact on clinical pregnancy and implantation rates unless other previously reported signs of difficult transfer are also observed.