移植胚胎数及移植优质胚胎数对妊娠结局的影响

目的：探讨体外受精-胚胎移植（IVF—ET）周期中，移植胚胎数及移植优质胚胎数对妊娠结局的影响。方法：回顾性分析行辅助生殖（IVF／ICSI）治疗并新鲜移植的病例共4190个周期，根据患者年龄分为〈35岁组，35～37岁组和≥38岁组，分别统计各年龄段移植1、2、3个胚胎和移植0、1、2、3个优胚的临床妊娠率、单胎妊娠率、多胎妊娠率和异位妊娠率。结果：（1）〈35岁组中，移植1、2个胚胎的临床妊娠率无统计学差异，移植1、2个优胚者获得了相似的临床妊娠率，显著高于无优胚移植者；移植2个优胚者，多胎妊娠率显著高于移植1个优胚者。（2）35-37岁组，移植2个或3个胚胎的临床妊娠率无统计学差异，且明显高于移植1个胚胎者；移植1、2、3个优胚的临床妊娠率显著高于无优胚移植者，同时移植3个优胚者，其多胎妊娠率及异位妊娠率均显著增加。（3）在≥38岁组中，无论是移植2个或3个胚胎，还是2个或3个优胚，其临床妊娠率均显著高于移植1个胚胎及1个优胚者，且移植3个优胚者其多胎妊娠率及异位妊娠率也明显提高。结论：年龄〈35岁的患者和35—37岁的患者可以分别选择1个和2个优质胚胎移植，年龄≥38岁的患者应尽量避免移植3个优质胚胎，以减少多胎妊娠及异位妊娠的发生。

Impact of numbers of embryos and prime embryo transfer on pregnancy outcome

Objective： To explore the impact of numbers of embryos and prime embryos transfer at different ages on pregnancy outcome. Methods： Four thousand one hundred and ninety fresh cycles from infertile patients who underwent in vitro fertilization-embryo transfer （IVF-ET） were retrospectively analyzed. The patients were divided into group 1 （younger than 35 years）, group 2 （between 35 and 37 years） and group 3 （38 years and older）. The pregnancy outcomes were compared and analyzed among the three groups. Results： （1）In group 1, no statistically significant difference was found in clinical pregnancy rate, and the multiple pregnancy rate and ectopic pregnancy rate in patients who received two prime embryo transfer were higher than those who received one. （2）In group 2, no statistically significant difference was found in clinical pregnancy rate whether two or three embryos transferred, and obviously higher than those who received one embryo transfer. The multiple pregnancy rate and ectopic pregnancy rate in patients who received three prime embryo transfer were obviously higher. （3）In group 3, the clinical pregnancy rate was significantly lower than group 1 and group 2, and the multiple pregnancy rate and ectopic pregnancy rate in patients who received three prime embryo transfer were higher than those received one or two. Conclusion： One prime embryo transfer is advised for patients younger than 35 years, and one or two prime embryo transfer for the patients between 35-37 years. For the patients aged 38 and older, they should carefully select three prime embryos to reduce the risk of multiple pregnancy and ectopic pregnancy.