体外受精-胚胎移植后妊娠数目与结局的关系

目的:通过比较体外受精-胚胎移植后双胎妊娠和单胎妊娠结局,分析多胎妊娠减胎的风险,探讨体外受精-胚胎移植后双胎行减胎术的可行性。方法:回顾性分析2005年2月至2008年10月在我院生殖中心接受体外受精/单精子卵胞浆内注射-胚胎移植(IVF/ICSI-ET)治疗的病例,胚胎移植后30 d B超检查确诊为宫内妊娠者561例为研究对象,根据妊娠结局分为3组,A组:双胎妊娠患者,138例;B组:3胎减胎为双胎者,30例:C组:单胎妊娠者,393例。比较各组之间的流产率、早产率及新生儿出生情况。结果:A组与B组相比,早期流产率、晚期妊娠丢失率、早产率及低体重儿出生率差异均无统计学意义;A组与C组相比,早期妊娠丢失率有所增加但差异无统计学意义,晚期妊娠丢失率则显著增加,早产率及低体重儿出生率也显著增加,其相对危险度分别为8.77和14.41。结论:体外受精-胚胎移植后多胎行减胎术并不增加不良妊娠风险,而单胎妊娠则可显著降低流产、早产及低体重儿出生等风险从而改善妊娠结局,因此IVF后行双胎减胎术是可行的。

Outcomes of Twin or Multiple Pregnancy After IVF-ET

Objective: To compare the outcome of pregnancy between twin pregnancy and singleton pregnancy after in vitro fertilization and embryo transfer(IVF-ET),and to evaluate the feasibility of fetal reduction in twin pregnancy after in IVF-ET.Methods: A retrospective and comparative study of 561 women accepted IVF/ICSI-ET treatment was carried out.A final diagnosis of intrauterine gestation was made by ultrasound on the 30th day after embryo transplanting in all the subjects,and of which,138 women got twin pregnancy without fetal reduction(group A),30 women got twin pregnancy with fetal reduction(group B),and 393 women got singleton pregnancy(group C).The abortion rate,premature birth rate,and natality of low birth weight among these groups were compared.Results: No significant differences were found in the abortion rate and premature rate between group A and group B.The abortion rate in the early phase of group A was not significantly higher than that in group C,except in the later phase.The premature rate and the natality of low birth weight in group A were significant higher than that in the group C,and the relative risk was 8.77 and 14.41 respectively.Conclusion: After IVF-ET,the risk of abortion and premature birth between twin pregnancy with and without fetal reduction has no significant difference,while the risks of abortion and premature birth of twin pregnancy were greatly higher than that of the singleton pregnancy respectively.Therefore,fetal reduction won't increase the abortion and premature birth risk,so it is feasible that women of twin pregnancy after IVF-ET receive fetal reduction.