121例冻融胚胎移植周期回顾性分析

目的探讨影响冷冻胚胎复苏移植妊娠率的因素。方法收集2010年01月到2011年12月份在本中心进行冷冻胚胎解冻移植121个周期的资料,进行回顾性分析。结果 （1）121个周期中有35个周期获临床妊娠,周期临床妊娠率为28.92%;（2）妊娠组与非妊娠组间解冻后胚胎的优质胚胎率有显著性差异（P〈0.05）;（3）自然周期和激素替代周期间妊娠率无显著性差异（P〉0.05）,但在激素替代周期中妊娠组与非妊娠组间E2水平有显著性差异（P〈0.05）;（4）D2及D3冷冻胚胎复苏移植,妊娠率上亦无显著性差异（P〉0.05）。结论优质胚胎是冻融胚胎移植周期获得妊娠的关键,在激素替代周期中较高的雌激素水平更有利于胚胎的着床。     

不同内膜准备方法对卵裂期胚胎解冻移植妊娠结局的影响

目的三种不同内膜准备方法在卵裂期胚胎解冻移植后对妊娠结局的影响。方法回顾性分析2015年2至2018年2月在本生殖中心卵裂期胚胎解冻移植(FET)治疗的856个周期的资料,依据三种不同的内膜准备方法分成三组:A组:自然周期组冻融胚胎解冻移植241例;B组:人工周期组冻融胚胎解冻移植293例;C组:促排卵周期组冻融胚胎解冻移植322例。比较三组解冻胚胎的复苏率、妊娠率、流产率、宫外孕率等指标是否存在差异。结果三种不同内膜准备方法的胚胎解冻复苏率、妊娠率、流产率、宫外孕率等差异无统计学意义(P0.05)。结论在冻融卵裂期胚胎解冻中,不同的内膜准备方法不影响其妊娠结局,在临床的工作中可以根据患者的具体情况,个体化的选择方法准备内膜。     

冻融胚胎移植周期不同方案血P/E_2水平与妊娠结局关系

目的探讨冻融胚胎移植周期不同内膜准备方案血清P/E_2水平与妊娠结局的关系。方法对郑州大学附属洛阳中心医院自2014年1月至2015年1月行冻融胚胎解冻移植678周期进行总结分析。根据内膜准备方案不同分为自然周期组(118例),激素替代周期组(511例),降调节+激素替代周期组(49例),比较各组移植当日激素水平。根据临床结局分为临床妊娠组(364例),未妊娠组(314例),根据是否活产分为活产组(213例),未活产组(465例),分别比较各组移植日激素水平。结果三种内膜准备方案临床妊娠率和活产率差异无统计学意义(P0.05),激素替代周期组雌激素水平明显高于降调节激素替代周期组和自然周期组,差异有统计学意义(P0.05);自然周期组、激素替代周期组孕激素水平明显高于降调节激素替代周期组,差异均有统计学意义(P0.05);自然周期组P/E_2水平明显高于降调节激素替代周期组和激素替代周期组,差异均有统计学意义(P0.05)。妊娠组与非妊娠组,活产组与非活产组间内膜厚度差异无统计学意义(P0.05),孕激素和孕雌激素比值在妊娠组和活产组均分别明显高于非妊娠组和非活产组,而雌激素均分别明显低于非妊娠组和非活产组,差异均有统计学意义(P0.05)。46.16P/E_2≤94.16组临床妊娠率和活产率均高于其余三组,差异有统计学意义(P0.05)。结论雌孕激素比值可能通过内膜容受性影响临床妊娠结局。     

冻融D3胚胎当天和过夜培养后移植临床结局分析

目的探讨解冻移植(FET)周期中第3天(D3)胚胎解冻后当天移植和解冻后过夜培养后移植对临床结局的影响。方法回顾性分析本中心2013年5月-12月551例移植胚胎数≥2个D3胚胎FET周期临床结局,根据解冻后胚胎培养时间分为当天移植组(2h-3h)和过夜培养移植组(18h-20h)。再将两组按解冻前胚胎级别分为优胚组(≥2个II级胚胎)、混合胚组(1个II级+≥1个III级胚胎)和一般质量胚胎组(≥2个III级胚胎)。结果 FET周期中,对优胚、混合胚胎和一般质量胚胎,18h-20h组和2h-3h组年龄、平均移植胚胎数和种植率均没有显著差异(P0.05)。对各级别胚胎,18h-20h组临床妊娠率较2h-3h组有了一定提高(分别为43.21%vs 37.27%;31.37%vs 28.13%;29.41%vs 21.52%),但差异不显著(P0.05)。结论 D3胚胎解冻后过夜培养(18h-20h)不能显著提高D3胚胎FET周期临床妊娠结局。但是,提前解冻有利于实验室灵活安排工作。     

卵裂期胚胎提前解冻培养过夜对冻融移植周期临床结局的影响

目的探讨玻璃化冻融周期中卵裂期胚胎当天解冻移植和提前1天解冻过夜培养后移植对妊娠结局的影响。方法选择武汉大学中南医院生殖医学中心2015年1月-2018年6月的414个冻融卵裂期胚胎移植周期进行回顾性分析。根据胚胎解冻和培养的时间点,分为当日解冻组(A组,207个周期)和提前解冻组(B组,207个周期);根据患者的年龄,A组B组又分别分成3个亚组,即年龄<30岁(A1,B1);年龄31~35岁(A2,B2)和年龄>35岁(A3,B3),比较各组间的种植率、临床妊娠率、活产率及流产率等的差异。结果A1组与B1组的临床妊娠率、种植率、活产率及流产率分别为47%vs 65.3%,30.3%vs 45.4%,36.4%vs 52.3%,15%vs 13.9%;A2组与B2组的临床妊娠率、种植率、活产率及流产率分别为54.8%vs 71.8%,38.2%vs 51.5%,46.6%vs 60.7%,21.9%vs17.6%;A3组与B3组的临床妊娠率、种植率、活产率及流产率分别为38.2%vs 52.9%,24.8%vs 37.3%,25%vs 36.8%,35.5%vs 29.2%;提前解冻在不同年龄组均可显著改善妊娠结局,差异均有统计学意义(P<0.05)。此外,无论是否提前解冻,年龄>35岁组的活产率均显著低于≤30岁组和31岁~35岁组(P<0.05),而妊娠率和种植率较其他两组亦呈现降低趋势,但差异无显著性。结论冻融卵裂期胚胎提前解冻培养后再进行移植能改善妊娠结局,并且随着女性年龄的增高,活产率均会随之下降。     

冷冻时间对冻融胚胎移植周期结局的影响

目的探讨受精后第二天（D2）和第三天（D3）人胚胎冷冻对冻融胚胎移植周期结局的影响。方法回顾性分析本中心403个D2和D3胚胎程序化慢速冷冻-快速解冻周期,冷冻复苏后的胚胎存活率、完整率、种植率、临床妊娠率等指标。结果 D2冻融移植周期291个,存活率98.2%,完整率78.5%,胚胎种植率16.9%,临床妊娠率33.0%;D3解冻移植周期112个,存活率95.8%,完整率67.5%,胚胎种植率21.5%,临床妊娠率34.8%。D2比D3能显著提高胚胎存活率和完整率（P〈0.05）,但在临床妊娠率、胚胎种植率上无显著性差异。D2和D3胚胎在当天和提前解冻组的临床妊娠率、胚胎种植率差异没有显著意义。结论 D3胚胎冷冻没有比D2胚胎更有优势,D2胚胎对冷冻解冻可能具有更好的耐受。可以根据工作需要以及病人情况选择冷冻时间。     

体外受精中移植胚胎数目与临床妊娠结局的关系

目的探讨移植胚胎数目对临床妊娠结局的影响。方法根据移植胚胎数目的不同分为三组：1组为单胚胎移植组,2组为移植2个胚胎组,3组为移植3个胚胎组。分析三组患者移植的胚胎情况及移植后的临床妊娠结局。结果移植1个胚胎的妊娠率（20.7%）明显低于其它组（P〈0.05）,且流产率高（29.4%）,移植2个胚胎的妊娠率及种植率与移植3个胚胎的相似,但移植2个胚胎的流产率和多胎率明显低于移植3个组（P〈0.05）。结论单胚胎移植可以降低多胎率,但妊娠率偏低,移植2个胚胎可以获得较高的妊娠率并且可以降低多胎率的发生。     

冷冻胚胎复苏移植中子宫内膜最佳容受时间的研究

目的 分析在冷冻胚胎复苏移植过程中，各种内膜准备的方案中的内膜转化后不同转化时间移植对妊娠率的影响。方法 回顾性分析2020年2至12月在广西壮族自治区生殖医院行冷冻囊胚复苏移植的1147周期，分析不同的内膜准备方案中不同的转化时间移植胚胎的妊娠率。结果 在激素替代周期中，内膜转化第5天移植的临床妊娠率为57.75%，内膜转化第6天移植的临床妊娠率为51.22%，两者妊娠率差异无统计学意义（P=0.413）。在自然周期自然排卵中，卵泡排卵第4天移植的临床妊娠率为42.86%，胚胎种植率为28.57%，排卵第5天移植临床妊娠率为62.04%，胚胎种植率为46.99%，排卵第6天移植临床妊娠率为64.71%，胚胎种植率为45.16%，排卵第7天移植无1例妊娠，四组的临床妊娠率总体差异无统计学意义（P=0.065），排卵第7天移植的胚胎种植率分别与排卵第5天移植和排卵第6天移植的胚胎种植率比较，差异均有统计学意义（P=0.038,P=0.033）。在自然周期注射HCG第5天移植的临床妊娠率为62.16%，注射HCG第6天移植的临床妊娠率为57.29%，注射HCG第7天移植临床妊娠率为54.5...     

冻融胚胎和冻融囊胚对移植周期和分娩结局影响的比较

背景：自从1983年人类首例冷冻胚胎移植取得成功以来,胚胎冷冻技术已成为人类辅助生殖技术中重要组成部分。对选择冻融胚胎还是选择冻融囊胚移植,各地都有不少争议。 目的：比较解胚胎和囊胚经过低温保存解冻复苏后的分娩结局及新生儿状况。 方法：比较冻融胚胎移植周期1 273例和冷冻囊胚移植周期471例两组妊娠率、流产率、异位妊娠率、早产率、平均早产孕周、足月产率、平均足月产孕周、新生儿男女性别比例、出生体质量、出生缺陷等指标。 结果与结论：冻融囊胚解冻周期478例,移植周期471例(其中7例无囊胚移植取消),妊娠236例,分娩201例,分娩胎数251胎,男孩140个,女孩111个。冻融第3天胚胎解冻周期1 280例,移植周期1 273例(其中7例无胚胎移植取消),妊娠415例,分娩343例,分娩胎数431胎,男孩225个,女孩206个。冻融囊胚的妊娠率显著高于冻融胚胎妊娠率。冻融胚胎和囊胚的流产率、异位妊娠率、早产率、平均早产孕周、足月产率、平均足月产孕周、新生儿男女性别比例、出生体质量等差异无显著性意义。冻融胚胎和冻融囊胚移植出生缺陷并未明显增加。结果表明冻融囊胚与冻融胚胎的分娩结局及新生儿状况差异无显著性意义,但冻融囊胚的妊娠结局优于冻融胚胎的妊娠结局。 中国组织工程研究杂志出版内容重点：肾移植;肝移植;移植;心脏移植;组织移植;皮肤移植;皮瓣移植;血管移植;器官移植;组织工程全文链接：     

胚胎移植术14～16天后单次血HCG值与多胎,胎儿性别和临床流产之关系

目的探讨在胚胎移植（ET）后第14～16天单次血HCG值与临床妊娠最终结局的关系。方法 329例常规超促排取卵移植后第14～16天检测血HCG值确定生化妊娠,于移植后35天腹部B超确定临床妊娠,追踪随访直至妊娠的最终结局。在329例临床妊娠中,有145例在移植后第14天测血HCG值;102例在移植后第15天测血HCG值;82例移植后第16天测血HCG值。并按照检测血HCG的时间,将随访的妊娠结局分为四组。多胎（包括双胎和三胎）组,单胎女婴组,单胎男婴组,临床流产组（包括早、中、晚期流产）,One-Way ANOVA检验分析移植血HCG水平与多胎,胎儿性别,临床妊娠流产的关系。结果 1.在移植第14-16天,血HCG水平在多胎组、单胎女婴组、单胎男婴组、临床流产组均逐渐降低,多胎组血HCG水平与单胎女婴组、单胎男婴组、临床流产组之间均存在统计学差异。2.在145例移植后第14天,单胎女婴组与单胎男婴组（P=0.037）、临床流产组之间（P=0.001）均存在统计学差异,单胎男婴组与临床流产组间未见明显统计学差异（P=0.202）。3.在移植第15及第16天,单胎女婴组与单胎男婴组未见明显统计学差异（P=0.204及P=0.379）,与临床流产组间有统计学差异（P=0.009及P=0.001）;而单胎男婴组与临床流产组无统计学差异（P=0.154及P=0.083）。结论胚胎移植后第14-16天血HCG值与临床妊娠最终结局有密切相关性。多胎妊娠组,单胎女性组,单胎男婴组,临床流产组的血HCG均值逐渐降低。多胎妊娠显著高于单胎组;临床流产组显著低于单胎女性组。单胎男婴组与临床流产组无统计学差异。     

IVF-ET新鲜周期移植不孕而冷冻周期妊娠的相关因素分析

目的探讨IVF-ET助孕治疗中新鲜周期移植不孕而后续的冷冻周期成功妊娠的原因以指导治疗。方法回顾性分析体外受精或单精子卵母细胞浆内注射-胚胎移植术（IVF/ICSI-ET）治疗患者950个周期,其中新鲜周期妊娠组780个周期和新鲜周期未孕冷冻周期妊娠组170个周期,比较两组患者年龄、不孕年限、病因及基础FSH水平、Gn使用情况、hCG日内膜、激素水平、卵泡数、获卵及胚胎情况的差异。采用单因素分析筛选出差异有统计学意义的因素进行多因素分析。结果经Logistic回归分析得出hCG日P4、hCG日E2/1000是妊娠的独立影响因素。hCG日P4（OR=1.653,P=0.015,95%CI：1.101～2.482）,hCG日E2/1000（OR=1.219,P=0.001,95%CI：1.085～1.369）。hCG日酮孕每增加1ng/ml,新鲜周期不孕而冷冻周期妊娠的风险将增加1.653倍。hCG日E2每增加1000pg/ml,新鲜周期不孕而冷冻周期妊娠的风险将增加1.219倍。结论 hCG日的P4和E2是导致新鲜移植不孕而冷冻周期妊娠的重要原因。P4和E2过高,可考虑放弃新鲜移植,采用冷冻移植。     

Comparison between oral and vaginal estrogen usage in inadequate endometrial patients for frozen-thawed blastocysts transfer

Endometrial preparation with exogenous estrogen is a common practice in frozen-thawed embryo transfer (FET) cycles. The objective of this study was to compare the clinical outcomes of two endometrial preparation groups, oral estradiol valerate tablets (OEV) group versus vaginal estradiol (VE) tablets group, in inadequate endometrium patients. This retrospective, single-center, cohort study of patients undergoing FET treatment between Jan. 2012 and Jun. 2013, at an academic IVF center, included 247 patients (cycles) with endometrial thickness < 8 mm on day 13 of the hormone replacement cycle: OEV group included 69 patients (cycles) who received continuous OEV from day 1 onwards up to the day of progesterone supplement, while VE group included 178 patients (cycles) who taken OEV from day 1 to day 12, and used VE tablets from day 13 till the day of progesterone supplement. Patients in VE group required more days and higher dosage of estradiol, but had thinner endometrium on the day of transfer. However, the increase of endometrial thickness was more, when compared to OEV-treated patients. The implantation rate and pregnancy rate were, though not significantly, higher in VE group. Conclusions: Longer time of administration and higher dosage of estradiol usage did not have adverse effects on the clinical pregnancy rate. VE tablets may promote endometrial development and pregnancy success in FET cycles could not verify. Further study is needed to confirm the vaginal estradiol action on frozen-thawed embryo transfer cycles.     

黄体中期E2变化对IVF-ET结局的影响

目的研究黄体中期（ET后第3日）E2变化对IVF—ET结局的影响。方法放免法检测270例首次行IVF—ET助孕患者注射HCG日和黄体中期的外周血E2水平，根据黄体中期E2变化分为增高组（Group Ⅰ）和降低组（GroupⅡ），GroupⅡ又根据E2降低百分比进一步分为A、B、C、D四组，比较各组的种植率和临床妊娠率。结果GroupⅠ和GroupⅡ之间以及A、B、C、D各组间的种植率和临床妊娠率均无显著统计学差异（P〉0．05）。临床妊娠组和未妊娠组在HCG日和黄体中期E2水平、黄体中期E2升高比率和降低比率方面均无显著统计学差异（P〉0．05）。结论单纯评价黄体中期E2水平变化不能预测IVF—ET结局。     

自然周期冻融胚胎移植的相关因素分析

目的探讨自然周期玻璃化冻融胚胎移植(FET)结局的影响因素。方法对于2008年1月1日至2010年12月31日在湖北十堰市人民医院生殖医学中心接受玻璃化冻融胚胎移植的361个自然周期的相关资料进行回顾性分析,比较妊娠组与未妊娠组之间的各种参数。结果与未妊娠组相比,年龄、胚胎质量、子宫内膜厚度、剩余胚胎个数、移植第4日与移植日的血清孕酮(P)差值均有显著性差异。结论在自然周期玻璃化冻融胚胎移植周期中,年龄、胚胎质量、子宫内膜厚度、剩余胚胎个数、移植第4日与移植日的血清孕酮的上升差值与妊娠有关。     

Biochemical monitoring during hormone replacement therapy cycles for transfer of cryopreserved embryos in patients with functional ovaries.

Biochemical monitoring was undertaken in 22 treatment cycles for women with normal ovarian function who underwent pituitary suppression with buserelin and administration of exogenous oestradiol (E2) and progesterone (P) for cryopreserved embryo transfer (ET). Eighteen transfers of 1-4 thawed embryos, on the third day of exposure to progesterone, resulted in five clinical pregnancies (27.8%) and one biochemical pregnancy. There was no difference between pregnant and non-pregnant patients in the number and quality of embryos transferred, age, weight or infertility diagnosis. Serum E2 level from days 10-17 (the late proliferative phase) of the therapy cycle were significantly higher in the pregnant group compared with the non-pregnant group (P less than 0.05--P less than 0.005). There were no significant differences in P levels between the two groups from the onset of progesterone administration to the end of the cycle. However, as might be expected, the mean E2/P molar ratio in the pregnant group was significantly higher at the time of ET (P less than 0.02). It is concluded that biochemical monitoring during the embryo replacement cycle is necessary to tailor drug dosages for individual requirements to achieve adequate E2 levels before ET. Alternative routes of oestradiol administration need to be considered in patients with poor E2 profiles.     

Mid-cycle serum levels of endogenous LH are not associated with the likelihood of pregnancy in artificial frozen-thawed embryo transfer cycles without pituitary suppression

BACKGROUND: The aim of the present study was to evaluate the association between clinical pregnancy and serum luteinizing hormone (LH) levels, assessed after 14 days of endometrial preparation with estradiol (E(2)) in the absence of pituitary suppression during a frozen-thawed embryo transfer (FRET) cycle. METHODS: A total of 513 patients undergoing their first FRET cycle (01/99 to 11/05) participated in this prospective study. Endometrium preparation for FRET was started on cycle day 1 and continued for a fixed period of 14 days with trans-dermal E(2) patches. On day 14, serum LH, progesterone and E(2) levels were assessed. On day 15, progesterone supplementation was initiated and patients underwent embryo transfer on day 17 or day 18. The association between clinical pregnancy and LH levels was evaluated in groups of patients defined according to Tukey's Hinges percentile analysis of LH levels on day 14. In addition, robust logistic regression was performed with the dependent variable clinical pregnancy and independent variables LH, progesterone, embryos score, cycle rank and gravidity. RESULTS: Age, BMI, parity, cycle rank, embryo number, embryo score, endometrial diameter, E(2) and progesterone were not significantly different in cycles with low (0.1-8.1 IU/l; n = 132), intermediate (8.2-19.4 IU/l; n = 238) and high (20.0-78.0 IU/l; n = 143) levels of LH, respectively. Clinical pregnancy rates were not significantly different in cycles with low [12.1%, 95% confidence intervel (CI) 7.6-18.8], intermediate (13.4%, 9.7-18.4) and high levels of LH (16.1%, 11.0-23.0). Robust logistic regression analysis indicated that embryo score [Odds ratios (OR) 1.04, 95% CI 1.02-1.06, P < 0.01] was statistically significantly associated with the likelihood of clinical pregnancy achievement, but not day 14 levels of LH or progesterone, gravidity or cycle rank. CONCLUSIONS: The likelihood of clinical pregnancy is not associated with serum LH levels on day 14 of an artificial FRET cycle. Hormonal monitoring of LH levels does not yield useful information with regard to cycle management and patient prognosis, and should therefore not be conducted.     

提前复苏分裂速率较慢胚胎对妊娠率的影响

目的探讨冻融胚胎移植(FET)周期中,提前一日复苏冷冻前分裂速率较慢的胚胎对妊娠结局的影响。方法回顾性分析哈尔滨医科大学附属第一医院生殖中心2006年3月至2009年9月561例FET周期中,移植冷冻前分裂速率较慢胚胎的周期共88个。其中,33个周期为移植当日复苏胚胎,培养1-4h后移植。55个周期为移植前一日复苏胚胎,培养18-24h移植。比较两组胚胎移植后的妊娠率和种植率。结果移植当日复苏组与移植前一日复苏组妊娠率(9.1%,32.7%)与种植率(4.2%,15.5%)均有显著性差异(P﹤0.05);而患者平均年龄、移植前平均内膜厚度、胚胎复苏存活率及100%卵裂球存活率均无显著性差异(P﹥0.05)。结论对冷冻前分裂速率较慢胚胎提前一日复苏,可提高临床妊娠率和种植率。     

高孕激素状态促排卵方案与其他3种促排卵方案体外受精-冻融周期的结果比较

目的 比较高孕激素状态下促排卵(PPOS)方案与其他3种不同促排卵方案的实验室和临床妊娠结局.方法 回顾性分析2019年6月～2020年1月在我院生殖中心行体外受精/卵泡浆内单精子显微注射(IVF/ICSI)共430个取卵周期和256个冻融周期,观察实验室相关数据、受精情况及妊娠结局的差异.结果 取卵周期中,PPOS方...     

Effect of developmental stage of embryo at freezing on pregnancy outcome of frozen-thawed embryo transfer

BACKGROUND: The study aim was to investigate the impact of the developmental stage of embryos on pregnancy outcome of frozen embryo transfer (FET). METHODS: The survival rates of embryos after thawing and pregnancy outcome following FET were compared retrospectively between three cryopreservation strategies utilizing either zygote, day 2 or day 3 embryo freezing. RESULTS: A total of 4006 embryos was analysed in 1657 thaw cycles. The highest (P < 0.0001) survival rate (all cells survived) was observed for zygotes (86.5%), followed by day 2 (61.7%) and day 3 (43.1%) embryos. FET was performed in 1586 (95.7%) of all thaw cycles, resulting in overall clinical pregnancy and implantation rates of 20.7 and 14.2% respectively. The delivery rate per transfer was 16.5%, and live birth rate per transferred embryo 11%. There were no significant differences in clinical pregnancy, implantation, delivery and birth rates between frozen zygote, day 2 and 3 embryo transfers. However, an elevated miscarriage rate was observed in the day 3 group (45%) compared with zygotes (21.3%; P = 0.049) and day 2 embryos (18.3%; P = 0.004). The overall efficacy of FET (birth rate per thawed embryo) was 7.3%. The efficacy was lower in day 3 group (4.2%) than in the zygote (7.1%; P = 0.082) and day 2 (7.6%; P = 0.027) groups. CONCLUSIONS: The developmental stage of embryos at freezing has a profound effect on their post-thaw survival, but seems to have little effect on rates of clinical pregnancy, implantation, delivery and birth after FET. The elevated miscarriage rate for day 3 frozen embryo transfers may be caused by damage during freeze-thaw procedures. The low survival rate and elevated miscarriage rate were both responsible for a reduced overall efficacy for day 3 FET when compared with zygotes and day 2 embryos.