影响冻融胚胎移植成功的因素分析

目的探讨影响冻融胚胎移植临床妊娠成功的因素.方法对1997年9月至2000年5月行冻融胚胎移植的53例60个周期的资料进行回顾性分析.结果22个胚胎复苏,成活178个胚胎,3个周期因复苏胚胎卵裂球破裂未移植,宫内移植57个周期,平均每个周期移植胚胎3个,周期临床妊娠率30%(17/57).妊娠与非妊娠者的超排卵周期的超排卵方案、卵泡数、获卵数、受精胚胎数、冻存胚胎数及注射绒毛膜促性腺激素前的血雌二醇、促黄体生成素、孕酮水平比较,差异均无显著性(P＞0.05).冻融胚胎移植周期的子宫内膜状态及复苏胚胎的质量与临床妊娠密切相关,17例妊娠者胚胎移植前子宫内膜均呈三线型,胚胎质量良好率(冻存前83.8%、复苏后76.8%,复苏后成活率82.4%)均明显高于非妊娠者(分别为60.7%、50.0%和66.3%),差异均有显著性(P＜0.05).结论胚胎形态良好、子宫内膜呈三线型是冻融胚胎移植后妊娠成功的保证,均质型子宫内膜不宜行胚胎移植.     

玻璃化冻融人卵裂期胚胎移植结局的影响因素分析

目的:探讨玻璃化冻融人第3天卵裂期胚胎移植结局的影响因素。方法:回顾分析977例1301个冻融胚胎移植周期,根据患者年龄、新鲜周期结局、移植胚胎质量等因素分组,比较各分组的胚胎植入率、临床妊娠率。结果:复苏3598个胚胎,存活3462个。周期临床妊娠率24.1%,出生婴儿291个。新鲜周期结局、移植胚胎质量组间胚胎着床率、临床妊娠率的差异有统计学意义(P<0.01)。子宫内膜准备方案、胚胎的复苏程度组间差异无统计学意义(P>0.05)。不同年龄组相同不孕年限亚组间的胚胎着床率、临床妊娠率的差异有统计学意义(P<0.05)。移植日子宫内膜厚度>12.0mm组与其他两组相比,胚胎着床率、临床妊娠率较高(P<0.05);不同FET次数组间,1次组的胚胎着床率、临床妊娠率明显高于其他两组(P<0.01)。非条件逐步logistic回归分析表明年龄(P<0.01,OR=0.43)、FET次数(2次组P<0.01,OR=0.30;3次组P<0.01,OR=0.19)、新鲜周期结局(P<0.01,OR=9.01)、移植胚胎质量(P<0.01,OR=3.52)与移植结局相关。结论:年龄、新鲜周期结局、移植胚胎质量等是影响冻融胚胎移植结局的重要因素。     

影响冻融胚胎移植妊娠结局的相关因素分析

目的:探讨影响冻融胚胎移植(FET)妊娠结局的相关因素。方法:回顾性分析324个周期行FET患者的临床资料,分析患者年龄、体质量指数(BMI)、移植日子宫内膜厚度、内膜准备方案、移植胚胎数等相关因素对FET妊娠结局的影响。结果:324个周期共解冻胚胎727个,复苏成活720个(99.0%),临床妊娠144例(44.4%),胚胎植入196例(27.2%)。其中自然内膜准备周期组和激素替代内膜准备周期组患者年龄、不孕年限、基础卵泡刺激素(bFSH)、基础黄体生成素(bLH)、基础雌二醇(bE2)、复苏胚胎数、移植胚胎数、移植日子宫内膜厚度、胚胎种植率及临床妊娠率组间均无统计学差异(P0.05)。年龄≤35岁组的临床妊娠率高于年龄35岁组,差异有统计学意义(P0.05);BMI≥24.0 kg/m2的肥胖组临床妊娠率与正常体质量(BMI=18.5~23.9 kg/m2)组无统计学差异(P0.05);移植日子宫内膜厚度≥7 mm组的临床妊娠率高于移植日子宫内膜厚度7 mm组,但差异无统计学意义(P0.05);各移植胚胎数组间临床妊娠率无统计学差异(P0.05)。结论:年龄是影响FET临床结局的重要因素,内膜准备方案、BMI、移植日内膜厚度、移植胚胎数对冻融胚胎移植临床结局无影响。     

高龄患者冻融胚胎移植中不同黄体支持方案对妊娠结局的影响

目的探讨不同黄体支持方案对高龄助孕患者行激素替代周期冻融胚胎移植(hormone replacement therapy-frozen-thawed embryo transfer,HRT-FET)时妊娠结局的影响。方法收集2011.01-2015.12期间行HRT-FET移植且年龄≥35岁患者的临床资料进行回顾性分析。依据内膜转化日不同黄体支持方案,分为黄体酮针组(A组,n=588),雪诺同组(B组,n=224),所有患者均口服地屈孕酮片(20 mg/d)。比较组间临床妊娠率、着床率、流产率、宫外妊娠率及活产率之间的差异。结果临床及实验室一般资料组间无统计学差异(P0.05),A组临床妊娠率(36.6%)及着床率(20.3%)较B组(27.2%和15.1%)高,差异有统计学意义(P0.05)。单因素及多因素Logistic回归分析显示,早期流产率组间差异有统计学意义(P0.05)。结论在高龄患者HRT-FET中,2种黄体支持方案妊娠结局相似,患者可根据个人经济情况选择。     

冻融胚胎移植妊娠结局及出生缺陷情况分析

目的:探讨冻融胚胎移植妊娠结局及出生缺陷情况.方法:回顾性研究本中心冻融胚胎移植654周期妊娠结局及出生儿随访观察.结果:654周期中有232例妊娠,临床妊娠187例(28.6%),早期流产31例(16.5%),晚期流产2例(1.1%),异位妊娠8例(4.2%),宫内宫外同时妊娠2例(1.1%).共分娩144例.分娩率23.6%,足月分娩117例(81.1%),早产27例(18.9%),单胎107例(74.3%),单胎早产率9.3%,双胎37例(25.9%),双胎早产率45.9%.获得新生儿180个,男婴89个,女婴91个,其中低体重儿27个(14.9%).新生儿出生缺陷4例,占2.2%,其中1例新生儿死亡.远期随访89例,111个出生儿,年龄1～6岁,新增出生缺陷4例,失访31例(25.8%).总的出生缺陷共8例(4.4%).结论:冻融胚胎移植的早期流产率增加,新生儿畸形发生率与新鲜周期相似,但长期随访出生缺陷率增高,该技术的安全性问题需得到重视,有待进一步随访研究.     

输卵管积液超声介入硬化治疗对冻融胚胎移植结局的影响

目的:探讨超声介入硬化治疗输卵管积液对冻融胚胎移植(frozen-thawed embryo transfer,FET)周期妊娠结局的影响。方法:回顾性分析输卵管积液的输卵管性不孕接受体外受精-胚胎移植(IVF-ET)未妊娠或未移植且有冷冻胚胎的患者FET周期的临床资料,按积液的处理方式分组:A组(观察组)121个周期,FET前行超声介入硬化治疗;B组(对照组)60个周期,FET前行输卵管近端结扎。结果:A、B组胚胎种植率(20.06%vs 20.63%)、临床妊娠率(40.50%vs38.33%)、流产率(14.29%vs 13.04%)、异位妊娠率(6.12%vs 0.00%)组间差异均无统计学意义(P0.05)。结论:输卵管积液超声介入硬化治疗可获得与输卵管近端结扎治疗近似的FET临床结局,且简单、经济、基本无创。     

输卵管积水患者冻融胚胎移植周期移植卵裂胚及囊胚妊娠结局的对比分析

目的:对比分析输卵管积水患者冻融胚胎移植(FET)周期中卵裂期胚胎及囊胚移植的妊娠结局。方法:回顾性分析2017年1月至2019年12月在空军军医大学唐都医院生殖医学中心合并输卵管积水患者行FET助孕的235个周期。根据移植不同时期胚胎,分为两组:卵裂胚组(n=132);囊胚组(n=103)。收集患者一般资料,包括女方年龄、男方年龄、体质量指数(BMI)、抗苗勒管激素(AMH)、不孕类型、不孕年限、不孕因素、输卵管积水诊断方式及分布情况、FET周期子宫内膜准备方案、移植日子宫内膜厚度及形态、移植次数、移植胚胎数、辅助孵化(AH);比较两组临床妊娠率、种植率、异位妊娠率、流产率及活产率等差异。结果:两组患者一般情况差异无统计学意义。FET周期临床资料中,移植胚胎数(1.88±0.33个vs 1.04±0.19个,P0.05)及AH比率(30.30%vs 23.30%,P0.05)卵裂胚组均显著高于囊胚组;移植日子宫内膜形态两组差异有统计学意义(P0.05)。妊娠结局中,临床妊娠率(42.42%vs 47.57%,P0.05)、种植率(30.12%vs 46.73%,P0.05)及活产率(36.36%vs 42.72%,P0.05)囊胚组均显著高于卵裂胚组,而异位妊娠率(8.93%vs 4.08%,P0.05)囊胚组显著低于卵裂胚组,两组流产率差异无统计学意义。通过多元回归模型校正后,临床妊娠率(OR 1.66,95%CI 1.06～2.52,P0.05)、种植率(OR 1.75,95%CI 1.46～3.18,P0.05)、异位妊娠率(OR 0.40,95%CI 0.01～0.92,P0.05)及活产率(OR 1.87,95%CI 1.49～3.07,P0.05),两组间差异有统计学意义。结论:对于输卵管积水患者,相较于移植卵裂期胚胎,FET周期行囊胚移植临床妊娠率、种植率及活产率更高,异位妊娠率更低,妊娠结局更好。【     

自然周期与激素替代周期准备内膜对冻融胚胎移植结局的影响

目的:探讨同一黄体支持剂量时两种内膜准备方案对冻融胚胎移植妊娠结局的影响。方法:回顾性分析2016年1月至2016年12月在兰州大学第一医院生殖医学专科医院采用自然周期和激素替代周期准备内膜,并采用相同剂量黄体支持的冻融胚胎移植(FET) 233例患者资料,其中自然周期121例,激素替代周期112例。比较不同内膜准备方案患者的年龄、体质量指数(BMI)、多囊卵巢综合征(PCOS)/排卵障碍比例、ICSI比例、移植胚胎数、移植日子宫内膜厚度、临床妊娠率、早期流产率、晚期流产率、早产率及活产率等。结果:自然周期组年龄大于激素替代周期组(31. 99岁vs 30. 89岁),BMI(21. 35 kg/m2vs 22. 23 kg/m2)、PCOS/排卵障碍比例(4. 13%vs 19. 64%)小于人工周期组,差异有统计学意义(P0. 05)。两组移植胚胎数、有优胚移植比例、胚胎种植率、多胎率比较,差异无统计学意义(P0. 05)。自然周期组和激素替代周期组患者临床妊娠率(57. 85%vs65. 18%)、早期流产率(13. 04%vs 15. 28%)、晚期流产率(1. 45%vs 4. 17%)、早产率(28. 81%vs36. 21%)、活产率(85. 51%vs 80. 56%)比较,差异无统计学意义(P0. 05)。结论:足量黄体支持的情况下,在冻融胚胎移植中自然周期和激素替代周期准备内膜均可获得相似的妊娠结局,临床工作中可根据实际情况灵活选择。     

三种黄体支持方案用于激素替代冻融胚胎移植的临床效果比较

目的 探讨阴道用黄体酮软胶囊联合口服地屈孕酮、阴道用黄体酮凝胶联合口服地屈孕酮和肌肉注射黄体酮在激素替代冻融胚胎移植(HRT-FET)中的临床效果.方法 回顾分析2015年1月至2017年12月广东省妇幼保健院生殖健康与不孕症科冻融胚胎移植共1130周期,按照黄体支持方法分成阴道用黄体酮软胶囊联合地屈孕酮组114周期(...     

冻融胚胎移植时间与子宫内膜转化时间对妊娠结局的影响

目的:探讨冷冻胚胎移植周期(FET)中冻融胚胎移植时间与孕酮作用内膜时间对临床结局的影响。方法:回顾分析2013年8月至2016年1月在广东省妇幼保健院生殖中心行FET周期的1609例不孕患者的妊娠结局,按孕酮作用内膜时间(天)-移植第几天胚胎(天)分为3-3组、3-4组、4-3组和4-4组。结果:各组患者的基本特征之间均无统计学差异。孕酮作用内膜时间与移植胚胎时期同步时,4-4组的种植率(37.3%)明显高于3-3组(25.4%)(P<0.05)。孕酮作用内膜4天时,4-3组的种植率与临床妊娠率(23.4%,34.4%)明显低于4-4组(37.3%,53.1%)(P<0.05)。3-3组和3-4组、3-3组和4-3组及3-4组和4-4组的临床妊娠率、种植率和流产率均无统计学差异(P>0.05)。结论:冻融胚胎移植中,同时延迟孕酮作用时间与胚胎移植时间到第四天有更好的临床结局。移植相同天数胚胎时,孕酮作用内膜3天和4天的临床结局无差异。     

卵泡黄素化不破裂周期胚胎解冻移植的探讨

目的 研究卵泡黄素化未破裂（luteinized unruptured follicle，LUF）周期对胚胎解冻移植（frozen tha wed embryo transfer，FET）结局的影响。方法 选择本中心2004年1月～2004年12月期间行FET的有卵泡发育的周期．根据预期排卵日卵泡破裂与否分为排卵组（891例）及LUF组（158例），并对2004年11月～2004年12月进行解冻移植的患者分别于移植当日及移植后3d查血清E2和P，比较排卵组及LUF组的血清E2和P。结果 促排卵周期LUF发生率（35．90％）明显高于自然周期（16．16％），差异有显著性（P〈0．05）；经给予不同的黄体支持方案，LUF组移植日及移植后3d血清E2、P水平分别为（507．0±371．9）pmol／L、（62．1±58．2）nmol／L，E2／P为（13．4±12．7）；而正常排卵组则分别为（436．2±298．5）pmol／L，（46．7±39．62）nmol／L及（11．6±11．3），两组相比差异无显著性（P〉0．05）；LUF组临床妊娠率及继续妊娠率分别为27．85％（44／158例）和22．78％（36／158例），而正常排卵组则分别为31．43％（280／／891例）和26．04％（232／891例），差异无显著性（P〉O．05）。结论 LUF周期同样可进行胚胎解冻移植，可获得与正常排卵相似的临床妊娠率，LUF周期解冻移植不影响其结局。     

Clinical evaluation of frozen/thawed embryo transfer following transport of oocytes and embryos

Background and Aims  We evaluated the efficacy of the transport oocyte/embryo frozen/thawed embryo transfer method, in which oocytes or embryos were transported from satellite clinics to the main assisted reproductive technology (ART) center, and surplus embryos were placed in cryopreservation. Methods  We evaluated 41 cycles in 34 patients in the transport oocyte group (TO group). In the TO group the oocytes were collected at the satellite clinics, transported to the main ART center and underwentin vitro fertilization or intracytoplasmic sperm injection. Surplus embryos were used for frozen/thawed embryo transfer. We also evaluated 17 cycles in 10 patients in the transport embryo group (TE group), where surplus embryos were transported to the main ART center and used for frozen/thawed embryo transfer; and 189 cycles in 134 patients in the center group (C group), where surplus embryos collected at the same time at the main ART center were used for frozen/thawed embryo transfer. Oocytes were transported from satellite clinics in HEPES buffered human tubal fluid (HTF) culture medium, and embryos in 30% synthetic serum substitute + HEPES buffered HTF, using a portable incubator we devised. Results  The proportions of undamaged embryos after freeze/ thawing were 47% for the C group, 46% for the TO group, and 46% for the TE group. The numbers of embryos transferred were 2.0 ± 0.7 for the C group, 2.0 ± 0.6 for the TO group, and 2.2 ± 0.4 for the TE group. The rate of embryo transfer was 63% for the C group, 68% for the TO group, and 76% for the TE group. Pregnancy rates per patient were 16% for the C group, 24% for the TO group, and 40% for the TE group. The embryo survival rates (number of embryos with ≥50% viable blastomeres/total number of embryos) were 55% for the C group, 60% for the TO group, and 54% for the TE group. No significant differences were seen between the C group and either the TO or TE groups in any of these parameters. Conclusions  Favorable results were achieved with the transport oocyte/embryo frozen/thawed embryo transfer method, and it is suitable for widespread clinical application.     

Case of heterotopic cervical pregnancy and total placenta accreta after artificial cycle frozen‐thawed embryo transfer

Case

A 39‐year‐old woman presented with a genital hemorrhage at 5 weeks of gestation after an artificial cycle double frozen‐thawed embryo transfer. She was diagnosed with a cervical heterotopic pregnancy. Although hormone supplementation was discontinued to terminate the pregnancy at 5 weeks of gestation, the intrauterine and cervical gestational sacs continued to develop.

Outcome

The cervical gestational sac was surgically removed and the intrauterine pregnancy continued uneventfully, except for vasa previa. At 36 weeks of gestation, the patient underwent a cesarean section and gave birth to a healthy female infant. At the delivery, massive bleeding occurred and a hysterectomy was performed due to total placenta accreta.

Conclusion

This case provides a novel example of a near‐term delivery after a cervical heterotopic pregnancy and emphasizes the need for intensive care, even after the successful management of a cervical pregnancy. Most importantly, the present case implies a possible link between hormonal withdrawal and abnormal placentation.     

多囊卵巢综合征妇女体外成熟卵母细胞胚胎慢速冷冻复苏移植结局分析

目的评价未成熟卵母细胞体外成熟（IVM）后形成的卵裂期胚胎经慢速冷冻一解冻后的发育能力。方法将2006年1月至2010年12月北京大学第三医院因多囊卵巢综合征（PCOS）合并不孕症行卵裂期胚胎复苏移植的385例患者分为两组：复苏胚胎来源于体外成熟的卵母细胞组（IVM组,46例）和复苏胚胎来源于常规体内成熟的卵母细胞组（IVF组,339例）。采用慢冻速溶法解冻移植后比较两组患者的临床结局。结果IVM组复苏胚胎243枚,复苏后存活162枚,复苏率为66．67％;IVF组复苏胚胎1605枚,复苏后存活1082枚,复苏率为67．41％,两组比较,差异无统计学意义（P〉0．05）。IVM组患者的临床妊娠率和着床率分别为19．30％（11／57）和10．61％（14／132）,明显低于IvF组临床妊娠率（45．45％,175／385）和着床率（26．14％,240／918;P均〈O．05）。结论体外成熟卵母细胞发育形成的卵裂期胚胎慢速冷冻后临床结局欠佳,可能与冻融前胚胎自身的发育潜力有关。     

Predictive value of hCG level 14 days after embryo transfer

Objective It has been reported that the quantitative serum hCG level 14 days after embryo transfer (ET) correlated with pregnancy outcome as well as a likelihood of a multiple gestation pregnancy. This prospective study was designed to assess the predictive value of a 14-day post-ET hCG level with pregnancy outcome and multiple gestation pregnancies.Methods Patients undergoing in vitrofertilization (IVF) and ET were monitored by serum quantitative hCG levels 14 days after ET. If positive, serial values of hCG were obtained and transvaginal ultrasound was performed 3 weeks after ET and weekly until fetal cardiac activity was seen. Ongoing pregnancies were defined as greater than 20 weeks.Results One hundred eleven patients had positive serum quantitative hCG levels 14 days post-ET; 89/111, or 80.2%, had ongoing pregnancies. The spontaneous miscarriage rate was, therefore, 19.8% (22/111). If the level was less than 300, the ongoing multiple pregnancy rate was 9% (5/57). If the level was between 300 and 600, the ongoing pregnancy rate was 40% (10/25). If the hCG level was greater than 600, the multiple pregnancy rate was 100% (7/7).Conclusions These data support the hypothesis that hCG levels greater than 200 mIU/ml on 14 days post-ET are more likely to have ongoing pregnancies; hCG levels greater than 600 have a high likelihood of a multiple gestation pregnancy.Presented at the 50th Annual Meeting of the American Fertility Society, San Antonio, Texas, November 5–10, 1994.     

Effect of luteinized unruptured follicle cycles on clinical outcomes of frozen thawed embryo transfer in Chinese women

OBJECTIVE: To determine the effect of luteinized unruptured follicle (LUF) cycles on frozen thawed embryo transfer (FET). DESIGN: A retrospective analysis comparing the clinical outcomes after FET among 144 cases of luteinized unruptured follicle (LUF) cycles and 866 cases of ovulation cycles. SETTING: Reproductive medical center, Beijing China. PATIENTS: Chinese infertile women who underwent FET. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Clinical pregnancy rate (PR), implantation rate. RESULTS: The implantation rate, clinical pregnancy rate, on-going pregnancy rate and live birth rate in LUF group were 12.76% (49/384), 27.78% (40/144), 24.31% (35/144) and 19.44% (28/144), respectively, and in ovulation group, 14.74% (332/2251), 31.29% (271/866), 28.29% (245/866) and 22.23% (193/866), respectively (p > 0.05). CONCLUSIONS: LUF does not affect the clinical outcomes of FET. Patients of LUF should be included in FET treatment.