冻融后不同时期和数目胚胎移植的临床妊娠结局比较

目的 比较冻融后对不同时期和数目的胚胎进行移植的临床妊娠结局.方法 选取广东省妇幼保健院2014年7月至2015年7月期间进行玻璃化冷冻并复苏培养的胚胎作为研究对象,共992个移植周期,均对D3卵裂期胚胎进行玻璃化冷冻后复苏,培养1d后进行移植.根据移植胚胎数目和桑椹胚数目分为单个胚胎移植非桑葚胚组(移植1个非桑葚胚,n=41)、桑葚胚组(移植1个桑葚胚,n=28)]和两个胚胎移植桑葚胚M0组(移植2个非桑椹胚,n=290)、桑葚胚M1组(移植1个非桑椹胚和1个桑葚胚,n=378)、桑葚胚M2组(移植2个桑葚胚,n=255)],分析各组间临床妊娠率、流产率、宫外孕率以及早产率.结果 单个胚胎移植时,桑葚胚组和非桑葚胚组的临床妊娠率(28.57%vs 29.27%)、流产率(5.00%vs 33.33%)、宫外孕率(0 vs 0)和早产率(12.50%vs 8.33%)比较差异均无统计学意义(P>0.05);两个胚胎移植时,随着移植桑葚胚数目的增加(桑葚胚M0组→桑葚胚M1组→桑葚胚M2组),临床妊娠率显著增加(42.41%→53.17%→66.27%),差异均有统计学意义(P<0.05);桑葚胚M0组、桑葚胚M1组和桑葚胚M2组的宫外孕率(2.44%vs 3.98%vs 2.37%)、流产率(11.38%vs 10.06%vs 12.94%)和早产率(19.51%vs 17.41%vs 24.26%)比较,差异均无统计学意义(P>0.05).结论 进行体外受精-胚胎移植时,选择D3胚胎解冻培养至桑葚胚期再行移植,能有效提高临床妊娠率,且不增加宫外孕、流产和早产的风险.

Clinical outcome of embryo transfer in different periods and numbers after freezing and thawing

Objective To investigate the clinical outcome of transfer after in different periods and numbers embryofreezing and thawing. Methods A total of 992 transplanting cycles of D3 cleavage stage embryo on vitrification from July 2014 to July 2015 in our hospital were selected. Embryos were recovered and then cultured for 1 day before transplantation. According to the number of transplanted embryos and morula embryos, they were divided into single em-bryo transfer which included the non-morula group (transplanted 1 non-morula, n=41) and the morula group (transplant-ed 1 morula, n=28) and two embryos transfer which included the morula group M0 (transplanted 2 non-morula, n=290), the morula group M1 (transplanted 1 non-morula and 1 morula, n=378) and the morula group M2 (transplanted 2 moru-la, n=255). The clinical pregnancy rate, abortion rate, ectopic pregnancy rate and premature delivery rate were analyzed. Results In single embryo transfer, there was no significance in clinical pregnancy rate (28.57% vs 29.27%), miscar-riage rate (5.00% vs 33.33%), ectopic pregnancy rate (0 vs 0) and preterm birth rate (12.50% vs 8.33) between the non-morula group and the non-morula group (P>0.05), indicating the transplanted morula has nothing to do with preg-nancy outcome. In two embryos transfer, the clinical pregnancy rate increased significantly (42.41%, 53.17%, 66.27%)with the increase of the number of transplanted morula (the morula group M0, the morula group M1 and the morula group M2) (P<0.05). There was no significant difference in the rate of ectopic pregnancy (2.44%, 3.98%, 2.37%), abor-tion rate (11.38%, 10.06%, 12.94%) and preterm birth rate (19.51%, 17.41%, 24.26%) amongthe those groups (P>0.05). Conclusion For in vitro fertilization and embryo transfer, it ts recommended that D3 embryos are thawed and cultured for 1 day to morula before transplantation, which can effectively improve the clinical pregnancy rate and do not increase the risk of abortion rate, ectopic pregnancy rate and premature delivery rate.