新鲜周期单囊胚移植314例临床结局

目的 探讨新鲜周期单囊胚移植(single blastocyst transfer,SBT)的可行性。方法 回顾性分析314个新鲜周期行SBT患者的临床资料,从年龄、囊胚分级等方面比较分析临床结局。结果 妊娠组患者的年龄显著低于未妊娠组(P0.001);选择性SBT(elective SBT,eSBT)组的临床妊娠率显著高于非选择性SBT(non-elective SBT,non-eSBT)组(P0.05);年龄≤35岁的患者,eSBT组的临床妊娠率与双囊胚移植(double blastocyst transfer,DBT)组无统计学差异,但多胎妊娠率显著降低(P0.001);而35岁的患者,eSBT组的临床妊娠率低于DBT组(P0.05),组间的多胎妊娠率无统计学差异(P0.05);囊胚扩张和孵化的程度与临床妊娠率显著相关,优质囊胚可获得更好的妊娠结局。结论 妊娠结局与囊胚的质量及患者的年龄显著相关,对于年龄≤35岁,有优质囊胚的患者,可以进行SBT。     

不同囊胚发育期对囊胚解冻移植周期临床结局的影响

目的 比较不同发育期别的囊胚对冷冻复苏的耐受程度及解冻移植的临床结局.方法 回顾性分析2012年1月至2013年12月北京大学第三医院生殖医学中心行囊胚冷冻与复苏移植的不孕症患者的临床资料,排除行植入前遗传学诊断、睾丸/附睾精子抽吸术及关键数据缺失的周期.分析解冻存活率与损伤率、着床率、宫内活胎率、临床妊娠率、活产率和...     

复苏周期中单/双囊胚移植患者的临床结局比较

目的:探讨复苏周期单囊胚和双囊胚移植对患者妊娠结局的影响。方法:回顾性分析行囊胚冷冻-复苏患者2 021例,其中单囊胚复苏移植组(A组)326例,双囊胚复苏移植组(B组)1 695例。比较单/双囊胚复苏移植对患者临床结局的影响及新生儿情况分析。结果:A组胚胎着床率、临床妊娠率、早产率、多胎率、低体质量儿率分别显著低于B组(P0.05);A组早期流产率、新生儿体质量、身长以及Apgar评分均显著高于B组(P0.05)。结论:单囊胚移植能够明显降低多胎率及产科风险。     

囊胚期与卵裂期胚胎培养及移植60例疗效比较

目的比较囊胚期与卵裂期胚胎培养及移植的疗效。方法2002年9月至2003年2月,中国医科大学第二医院采用序贯培养的方法,对30例(囊胚组)IVFET的患者进行囊胚培养及移植,并与30例(卵裂组)在胚胎卵裂期移植的IVFET患者作配对研究。囊胚组移植胚胎1～2枚,对照组移植胚胎3枚。比较两组的胚胎种植率、临床妊娠率及多胎妊娠率。结果囊胚组的胚胎种植率高于卵裂组(56.76%、17.78%),差异有显著性意义(χ2=9.44,P<0.05)。囊胚组的临床妊娠率高于卵裂组(59.29%、26.70%),差异有显著性意义(χ2=4.37,P<0.05)。囊胚组与卵裂组多胎妊娠率分别为31.25%、62.50%。结论囊胚期胚胎培养及移植的疗效优于卵裂期。     

不同发育天数冻融单囊胚移植的临床结局比较

目的:研究D5和D6天冷冻胚胎冻融单囊胚移植的临床结局,探讨不同发育天数囊胚的发育潜能,为进一步改进囊胚冷冻方案提供依据。方法:回顾分析922例复苏周期单囊胚移植患者的资料,根据冷冻时间不同,分为D5冷冻组(n=563)和D6冷冻组(n=359),待患者子宫内膜达到8~12mm时,复苏5h后移植。结果:D5冻冻组的生化妊娠率(63.23%)和临床妊娠率(56.48%)均显著高于D6冷冻组(50.97%和44.85%)(P≤0.01)。结论:D5冻融单囊胚移植相较于D6冻融单囊胚移植更有利于胚胎着床,获得更高的临床妊娠率。     

囊胚培养患者选择标准的建立及临床应用研究

目的:旨在建立一套能使更多患者从囊胚培养和移植中受益的选择标准。方法:回顾性分析2011年3月至2012年10月在云南省第一人民医院生殖医学中心实行的两套囊胚培养患者的选择标准。旧标准(844周期):D3选择2个评分最高的胚胎进行移植或冷冻后,若剩余胚胎≥7个,行囊胚培养;新标准(781周期):D3选择2个评分最高的胚胎进行移植或冷冻后,若剩余胚胎≥5个,行囊胚培养。对两组患者IVF的治疗结局进行比较。结果:新标准组患者的获卵数(18.01±7.01个)低于旧标准组(19.42±6.27个),差异有统计学意义(P=0.006);新标准组的患者无囊胚形成率(5.6%)高于旧标准组(2.3%),差异有统计学意义(P=0.001)。新、旧标准两组患者在囊胚形成率、优质囊胚形成率、囊胚复苏率、每周期冻融胚胎移植数、冻融囊胚移植临床妊娠率、囊胚种植率、多胎率和流产率上比较,差异均无统计学意义(P0.05)。结论:降低囊胚培养患者的选择标准可以使更多患者从囊胚培养和移植中受益。     

卵裂期评分对优质囊胚移植妊娠结局的预测价值探讨

目的:探讨优质囊胚的卵裂期胚胎评分对囊胚移植妊娠结局的预测作用。方法:回顾性分析2012年10月至2015年10月于中山大学附属第六医院生殖医学研究中心行新鲜或解冻优质囊胚移植的108例周期资料,其中移植来源于优质卵裂期胚胎的优质囊胚为H-H组(59例),移植来源于非优质卵裂期胚胎的优质囊胚为P-H组(49例)。比较两组移植情况及妊娠结局,并采用Logistic回归分析临床妊娠结局的相关因素。结果:H-H组59例均为单囊胚移植;P-H组中有42例为单囊胚移植;7例移植2枚囊胚(1枚优质囊胚及1枚非优质囊胚);H-H组的临床妊娠率及胚胎种植率较P-H组高(57.63%vs 34.69%,P=0.017;57.63%vs 32.14%,P=0.004),且流产率较后者低(16.13%vs 47.06%,P=0.039)。Logistic回归分析提示优质囊胚的卵裂期评分与临床妊娠结局相关(OR 2.560,P=0.019),而其他混杂因素与临床妊娠结局的关联差异无统计学意义(P0.05)。结论:卵裂期评分较低的胚胎,即使发育至优质囊胚,移植后妊娠率和流产率并不乐观,或不适用于优质单囊胚移植策略。优质囊胚的卵裂期评分可作为胚胎发育潜能的预测因素,改进优质单囊胚移植策略的实际应用。     

多胎妊娠选择性减胎术的时机对妊娠结局的影响

目的 比较不同孕周实施减胎术后的妊娠结局,分析选择性减胎术(简称减胎术)的手术时机对妊娠结局的影响. 方法 选择2002年1月至2012年2月期间,在山东大学附属省立医院产科就诊的辅助生殖技术(assisted reproductive technology,ART)后妊娠的双(多)胎妊娠孕妇302例,其中减胎组为三胎和四胎妊娠孕妇152例,分别于妊娠12～13+6(91例)、14～15+6(32例)、16～24+6周(29例)接受了减胎术,对照组为ART后妊娠的双胎妊娠孕妇150例.手术方法采用超声引导下经腹胎儿心脏注射氯化钾.采用回顾性分析方法,记录分娩孕周和新生儿出生体重,观察妊娠期糖尿病和妊娠期高血压疾病的发病情况.采用t检验、单因素方差分析或x2检验进行统计学分析. 结果 减胎组流产率(14.5％,22/152)高于对照组(6.7％,10/150),差异有统计学意义(x2=4.857,P＜0.05);妊娠16～24+6周减胎组流产率(31.0％,9/29)分别高于妊娠12～13+6周减胎组(8.8％,8/91)和对照组,差异均有统计学意义(x2分别为7.212、12.749,P＜0.05);妊娠12～13+6和14～15+6周减胎组流产率(15.6％,5/32)分别与对照组比较,差异均无统计学意义(x2分别为0.370、1.739,P＞0.05).减胎组和对照组的平均分娩孕周分别为(36.9±1.8)周和(37.0±1.8)周,重体重儿出生体重分别为(2720.4±455.0)g和(2729.1±413.8)g、轻体重儿出生体重分别为(2409.2±412.6)g和(2416.2±436.8)g,差异均无统计学意义(t分别为 0.346、-0.163、-0.136,P＞0.05).减胎组和对照组妊娠28～34周分娩率分别为6.2％(8/130)和6.4％(9/140)、胎儿生长不均称发生率分别为12.3％(16/130)和11.4％(16/140)、妊娠期糖尿病发病率分别为3.1％(4/130)和2.1％(3/140),妊娠期高血压疾病发病率分别为11.5％(15/130)和8.6％(12/140),差异均无统计学意义(x2分别为0.009、0.050、0.659、0.010,P＞0.05). 结论 实施选择性减胎术将多胎妊娠减至双胎,术后存在流产风险.掌握适宜的手术时机,在妊娠16周前手术,能够存一定程度上降低流产率.     

冻融囊胚移植周期生化妊娠相关因素分析

目的分析冻融囊胚移植周期中导致生化妊娠的相关因素。方法回顾性分析行冻融囊胚移植后生化妊娠的70个周期的临床资料,以同期冻融囊胚移植后正常宫内妊娠的336个周期为对照,比较影响生化妊娠相关因素。结果生化妊娠组年龄比正常宫内妊娠组大,合并亚临床甲状腺功能减退(SCH)及未治疗或治疗后仍不正常的患者生化妊娠组更多,差异有统计学意义(P0.05)。结论重视高龄患者、胚胎移植前纠正SCH,有助于降低冻融囊胚移植周期生化妊娠发生率。     

囊胚培养与囊胚移植的临床应用

目的:探讨囊胚培养与囊胚移植在临床上的应用价值。方法:将卵裂期胚胎延长体外培养至囊胚期,观察囊胚形成率及质量,分析卵裂期胚胎质量与囊胚形成的关系及囊胚形成与临床妊娠的关系。结果:387例患者3 513个胚胎进行囊胚培养,共获得1 489个囊胚,囊胚形成率为42.35%。Ⅰ￣Ⅱ级胚胎囊胚形成率显著高于Ⅲ￣Ⅳ级胚胎(P<0.01);移植第5、6、7日囊胚临床妊娠率比较差异有显著统计学意义(P<0.01),囊胚冷冻移植异位妊娠发生率显著低于卵裂期冷冻胚胎移植(P<0.01)。结论:①对一些形态学上认为无冷冻价值的非优质胚胎也可延长体外培养时间培养至囊胚,筛选出具有发育潜能的胚胎,从而可以最大限度地利用胚胎,减少患者的损失;②移植第5日形成的囊胚可获得更高的妊娠率;③囊胚移植可有效防止异位妊娠的发生。     

Elective Single Embryo Transfer in the Setting of Funded In Vitro Fertilization: Two Years’ Experience in an Ontario Hospital-Based Fertility Clinic

Objective

The objective of this study was to assess data from a fertility clinic and identify differences in patient and cycle characteristics, clinical pregnancy rates, and multiple gestation rates before and after fertility treatment funding and a policy of elective single embryo transfer were instituted by the Ontario government to reduce multiple gestations arising from fertility treatment.

Supernumerary Blastocyst Cryopreservation: A key Prognostic Indicator for Patients Opting for an Elective Single Blastocyst Transfer (eSBT)

Objective

To determine if patients, less than 40 years of age with or without day 5 cryopreservation (d5 cryo), compromise their pregnancy rate (PR) by choosing an eSBT.

Design

Retrospective analysis

Setting

University IVF center

Patients

2,203 non-donor fresh IVF cycles in women <40 years of age from January 2004 to January 2010.

Interventions

None

Main outcome measure(s)

Eggs retrieved, Embryos cryopreserved, Implantation Rates, Clinical Pregnancy Rates, Live Birth Rates, Spontaneous Abortion Rates

Results

Pregnancy outcomes in women <40 years with or without d5 cryo were compared according to whether patients underwent an eSBT versus a 2BT in non-donor fresh IVF cycles. Overall, eSBT was associated with elimination of twinning while maintaining a high clinical pregnancy rate in both groups with d5 cryo (75 % eSBT versus 72 % 2BT) and groups without d5 cryo (48 % eSBT versus 56 % 2BT).

Conclusions

In this study, patients <40 years of age have eliminated twinning by electively choosing to transfer a single blastocyst without compromising their PR if embryos are available for d5 cryo, and suffer only a non-statistically significant drop in their PR if there are no embryos available for d5 cryo in exchange for the benefit of eliminating the obstetrical risk of twinning.     

The Effect of Intramural Myomas Without an Intracavity Component on In Vitro Fertilization Outcomes in Single Fresh Blastocyst Transfer Cycles

Study Objective

To assess clinical pregnancy rate (CPR) and live birth rate (LBR) in the presence of non–cavity-deforming intramural myomas in single fresh blastocyst transfer cycles.

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。     

Elective Single Embryo Transfer: an update to UK Best Practice Guidelines

A significant number of multiple pregnancies and births worldwide continue to occur following treatment with Assisted Reproductive Technologies (ARTs). Whilst efforts have been made to increase the proportion of elective single embryo transfer (eSET) cycles, the multiple pregnancy rate or MPR remains at a level that most consider unacceptable given the associated clinical risks to mothers and babies, and the additional costs associated with neonatal care of premature and low birth weight babies. Northern Europe, Australia and Japan have continued to lead the way in the adoption of eSET. Randomised controlled trials or RCTs, meta-analyses and economic analyses support the implementation of an eSET policy, particularly in light of recent advances in ARTs. This paper provides a review of current evidence and an update to the eSET guidelines first published by Cutting et al. (2008) Cutting, R., Morroll, D., Roberts, S., Pickering, S., &; Rutherford, A. (on behalf of BFS and ACE). (2008). Elective Single Embryo Transfer: Guidelines for Practice British Fertility Society and Association of Clinical Embryologists. Human Fertility, 11, 131–146.[Taylor &; Francis Online] , [Google Scholar] intended to assist ART clinics in the implementation of an effective eSET policy.     

选择性单胚胎移植应用于OHSS倾向患者的初探

目的:探讨在IVF-ET过程中出现卵巢过渡刺激综合征(OHSS)倾向的患者实施选择性单胚胎移植的临床结局及对预防OHSS的作用。方法:将97例IVF-ET过程中出现OHSS风险的患者随机分为A组(n=59),进行择性单胚胎移植(eSET);B组(n=38),放弃本周期,实行全胚冷冻。比较A、B组患者中-重度OHSS的发生率及治疗情况,并计算eSET的临床指标。采用Logistic回归分析可能影响中-重度OHSS发生的原因;另外采用ROC曲线分析窦卵泡,取卵数与中-重度OHSS发生的关系。结果:A组(eSET)临床妊娠率为35.6%,胚胎种植率为35.6%,活产率为32.2%。A、B组中-重度OHSS住院率、平均住院天数、治疗情况、胸水发生率无统计学差异(P>0.05)。但在发生OHSS病例中,妊娠组平均住院天数增加、腹腔穿刺比例与非妊娠者比较明显增加(P<0.05);进入Logistic回归模型的危险因素为窦卵泡(OR=1.57,95%CI=1.18～2.09)及取卵数(OR=1.57,95%CI=1.02～1.47),P均<0.05,均为危险因素;窦卵泡与取卵数预测OHSS发生率的曲线下面积(AUC)分别为0.81(95%CI=0.68～0.93)和0.69(95%CI=0.57～0.82)。依据ROC曲线提示当窦卵泡数>15个和取卵数>22个时发生中-重度OHSS的可能性较大。结论:选择性单胚胎移植对于IVF过程中出现OHSS风险倾向的患者不失是一种选择,既保证了本周期一定的妊娠率,也没有明显增加中-重度OHSS的发生风险,但临床妊娠者可能病程较长、病情较严重。     

Factors affecting the success of human blastocyst development and pregnancy following in vitro fertilization and embryo transfer

Objective: To determine the factors affecting blastocyst development and pregnancy after IVF and ET.

Design: Retrospective analysis of data arising from a clinical trial.

Setting: Private in vitro fertilization clinic.

Patient(s): Fifty-six patients aged ≤40 years, undergoing IVF procedures for infertility, recruited specifically for blastocyst transfer.

Intervention(s): All zygotes were cultured to days 5 or 6 after insemination, and one to four of the most advanced blastocysts were transferred to the patient’s uterus.

Main Outcome Measure(s): Development of zygotes to blastocysts in vitro and pregnancy and implantation rates after ET.

Result(s): Fifty-one percent of all zygotes developed to blastocysts. Significant positive correlation between the number of blastocysts formed was observed with the number of oocytes, pronuclear zygotes, and eight-cell embryos formed. There was a negative correlation with male factor infertility. By day 5 or 6, 93% of the patients had at least one blastocysts, and the clinical pregnancy rate per transfer was 43% and the implantation per embryo transferred was 25%. No other clinical factor significantly affected the number of blastocysts formed, pregnancy rate, or implantation rate.

Conclusion(s): The numbers of oocytes, zygotes, and normally developing embryos in culture significantly affects the production of blastocysts in vitro. Male infertility significantly reduces blastocyst production. The number and the quality of the blastocysts transferred significantly influences clinical pregnancy rate.     

胚胎移植技术对体外受精-胚胎移植结果的影响——653例临床分析

目的:分析胚胎移植技术与体外受精后临床妊娠、种植率和继续妊娠率之间的关系。方法:回顾性分析653例新鲜胚胎移植,比较移植情况和临床结果之间的关系。结果:腹部超声引导下胚胎移植后临床妊娠率为47.3%,种植率25.0%,继续妊娠39.7%。移植管顶端位于宫内不同位置以及血染情况不影响结果。8.8%困难移植明显降低种植率(20%比26%),临床妊娠率也降低(35.8%比48.3%),但无统计学差异。结论:腹部超声引导下胚胎移植可以达到较好的临床结果。胚胎放置在宫腔内不同位置以及移植管血染不影响临床结果,但要尽量避免困难移植.     

Blastocyst culture after repeated failure of cleavage-stage embryo transfers: a comparison of day 5 and day 6 transfers

OBJECTIVE: To evaluate the efficacy of blastocyst transfer among patients with at least three previous cleavage-stage embryo transfer failures and to compare pregnancy and implantation rates of blastocysts according to the day of embryo transfer (day 5 or day 6 after oocyte retrieval). DESIGN: Retrospective clinical study. SETTING: Private ART center. PATIENT(S): One hundred forty-eight patients (with at least three failed cleavage-stage embryo transfers) undergoing blastocyst-stage embryo transfer. INTERVENTION(S): Embryos were grown for up to 6 days and only blastocyst-stage (cavitating) embryos were transferred on either day 5 or day 6 after oocyte retrieval. MAIN OUTCOME MEASURE(S): Clinical pregnancy and implantation rates. RESULT(S): Blastocysts transferred on day 5 implanted almost five times the rate of those transferred on day 6 (23% vs. 5%). Pregnancy rates were triple as high among the 73 day 5 patients compared to the 63 day 6 transfer patients (38% vs. 11%). The number of blastocysts formed and per embryo rates of blastocyst formation were both significantly higher for patients undergoing day 5 transfers: more blastocysts developed (3.0 vs. 2.1) and more were transferred (3.0 vs. 1.9). In addition, blastocyst formation rates were 46% and 33%, respectively, for both groups of patients. CONCLUSION(S): Blastocyst transfer (preferably on day 5 after retrieval) appears to be a successful and improved alternative for patients with multiple failed IVF attempts. Moreover, with blastocyst transfer there should be a reduction in multiple pregnancy risk, because fewer embryos have to be transferred.