三种不同受精方式的冻融胚胎和囊胚分娩结局及新生儿状况

目的比较三种不同受精方式的冻融胚胎和囊胚解冻移植后分娩结局及新生儿状况。方法回顾分析2012年1月～2013年4月于广西科技大学附属妇产医院生殖中心行冷冻胚胎移植（frozen—thawedembryotrans—fer，FET）治疗的2384个周期，按受精方式分为三组：A组常规体外受精（IVF）冻融胚胎解冻周期1436例，移植周期1429例，妊娠481例，分娩385例；冻融囊胚解冻周期545例，移植周期539例，妊娠284例，分娩238例。B组卵胞浆内单精子注射（ICSI）冻融胚胎解冻周期240例，移植周期239例，妊娠77例，分娩63例；冻融囊胚解冻周期66例，移植周期64例，妊娠28例，分娩23例。C组早期补救性卵胞浆内单精子注射（r-ICSI）冻融胚胎解冻周期65例，移植周期65例，妊娠16例，分娩14例；冻融囊胚解冻周期32例，移植周期31例，妊娠17例，分娩17例。比较三组妊娠率、流产率、异位妊娠率、早产率、平均早产孕龄、足月产率、平均足月产孕龄、新生儿男女性别比例、出生体重、出生缺陷等指标是否存在差异。结果A、B、C三组的冻融胚胎的妊娠率分别为33．6％、32．6％、24．6％，囊胚的妊娠率分别为52．7％、43．7％、54．8％，差异均无统计学意义（P〉0．05）。三组冻融胚胎和囊胚的流产率、异位妊娠率、早产率、平均早产孕龄、足月产率、平均足月产孕龄、出生体重、出生缺陷比较差异无统计学意义（P〉0．05）。A、B、C三组冻融胚胎的新生儿男女性别比差异有统计学意义（P〈0．05），而冻融囊胚的新生儿男女性别比差异无统计学意义（P〉0．05）。结论与常规IVF相比，ICSI、r-ICSI的冻融囊胚和冻融胚胎是安全有效的治疗手段。

Birth outcomes and neonatal status of frozen thawed embryos and blasto- cysts frozen by three different methods

Objective To compare birth outcomes and neonatal status of three different fertilization methods of frozen thawed embryos and blastocysts were thawed transplantation. Methods 2384 cycles from January 2012 to April 2013 in Reproductive Center of the Obstetrics and Gynecology Hospital Affiliated to Guangxi Science and Technology Universi- ty for frozen-thawed embryo transfer （FET） treatment were retrospectively analyzed, and they were divided into three groups according to the mode of fertilization： group A of conventional in vitro fertilization （IVF） embryo freezing and thawing thawing cycles in 1436 patients, transplant period in 1429 cases, 481 cases of pregnancy, 385 cases of deliv- ery; frozen thawedblastocyst thawing cycle in 545 cases, transplantation the cycle of 539 cases, 284 cases of pregnancy, 238 cases of delivery. Group B intracytoplasmic sperm injection （ICSI） in frozen thawed embryo transfer cycle defrost cycle in 240 eases, transplant period in 239 cases, 77 cases of pregnancy, 63 cases of delivery; frozen thawed blasto- cyst thawing cycles in 66 patients, transplant period in 64 cases, 28 cases of pregnancy, 23 cases of delivery. Group C of early rescue intracytoplasmic sperm injection （r-ICSI） in frozen thawed embryo transfer cycle defrost cycle in 65 cas- es, transplant period in 65 cases, 16 cases of pregnancy, 14 cases of delivery; frozen thawed blastocyst thawing cycles in 32 patients, transplant period in 31 cases, 17 cases of pregnancy, 17 cases of delivery. The pregnancy rate, abortion rate, ectopic pregnancy rate, premature delivery rate, average premature gestational weeks, term yield, average full- term gestational age, newborn sex, birth weight, birth defects and whether there are differences in index of three groupswere compared. Results Frozen thawed embryo pregnan- cy rate of group A, B, C were 33.6%, 32.6%, 24.6% re-spectively, and the blastoeyst pregnancy rates were 52.7%, 43.7%, 54.8% respectively, the differences were not statisti- cally significant （P 〉 0.05）. The frozen thawed embryo and blastoeyst rate of miscarriage, eetopie pregnancy rate, pre- mature delivery rate, average premature gestational weeks, term yield, average full-term gestational age, birth weight, birth defects in three groups had no statistically significant difference （P 〉 0.05）. Frozen thawed embryo newborn sex ratio in three groups had a significant difference （P 〈 0.05）, and the freezing thawing blastoeyst newborn sex ratio has no significant difference （P 〉 0.05）. Conclusion Compared with conventional in IVF, ICSI, early r-ICSI of frozen thawed blastoeyst and frozen thawed embryo is a safe and effective therapeutic method.