行IVF/ICSI各年龄段妇女早期单、双胎妊娠丢失的回顾性研究

目的:分析行IVF/ICSI的各年龄段妊娠妇女早期单、双胎妊娠胚胎丢失的影响因素。方法:回顾性分析行IVF/ICSI治疗,授精后第2日或第3日移植2~3个胚胎后单、双胎妊娠周期中早期妊娠囊丢失情况。结果:共收集到1 674个IVF/ICSI周期,孕6周单胚胎着床1 077例,双胚胎着床597例。孕12周时单胎和双胎的继续妊娠数分别为901例(83.66%)和548例(91.79%)(P<0.001)。双胎妊娠中,21例(3.52%)自然减胎成单胎,28例(4.69%)自然流产。单胎和双胎妊娠中,每个着床妊娠囊的丢失率分别为16.34%(176/1 077),6.45%(741/1 194)(P<0.001)。妊娠妇女早期妊娠囊丢失率单胎者高于同年龄段双胎妊娠者,26~37岁各年龄段妇女单胎与双胎妊娠丢失率间差异均有统计学意义(P<0.05),≥38岁妇女双胎妊娠丢失率显著增加。单胎妊娠组Gn每日用量显著高于双胎妊娠组(P<0.05),而受精率及优质胚胎率单胎妊娠组显著低于双胎妊娠组(P<0.001),Gn每日用量、受精率及优质胚胎率在妊娠丢失组和继续妊娠组间无统计学差异(P>0.05)。结论:双胎妊娠早期能获得更好的继续妊娠机会,随年龄增加尤其是≥38岁妇女,妊娠丢失显著上升。胚胎形态学质量好则有助于双胚胎着床,但是对继续妊娠没有直接明显的影响。

Analysis of Early Pregnancy Loss between Single and Twin Pregnant Women with Different Age

Objective: To analyze influencing factors of early pregnancy loss between pregnant women of single and twin gestations with different age.Methods: Analysis of the outcomes of 1 674 pregnancies after double or three embryos transfer on day 2 or 3 after IVF or ICSI treatment was performed retrospectively.Results: Of 1 077 single implantations at 6 gestation weeks,901 cases(83.66%) were ongoing pregnancies.Of 597 multiple implantations at 6 gestation weeks,548 cases(91.79%) were ongoing multiple pregnancies,at 12 gestation weeks,21 cases(3.52%) were ongoing singleton pregnancies and 28 cases(4.69%) ended in a spontaneous abortion.Loss rate per gestational sac was 16.34%(176/1 077) and 6.45%(241/1 194)(P<0.001) in singleton and twin gestations groups,respectively.Loss per gestational sac in singleton gestation group was significantly higher than that in twin gestations group with the same age,especially between 26-37 year-old(P<0.05).Loss per gestational sac in twin gestations group was significantly increased above 38 years old.The dose of Gn used per day was significantly higher(P<0.05),but the fertilization rate and the good-quality embryo rate were lower in singleton gestation group than those in twin gestations group(P<0.001).The dose of Gn used per day,the fertilization rate and the good-quality embryo rate had no significant differences between onging pregnancy group and pregnancy loss group(P<0.05).Conclusion: The chances of continuation of pregnancy was better in twin pregnancies,but decreased fast with increasing maternal age especially above 38 years old.Although multiple implantations at 6 gestation weeks was predominantly determined by morphological embryo quality,the continuation of pregnancy beyond 6 gestation weeks was independent on morphological embryo quality.