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目的探讨分析不同年龄阶段患者玻璃化冻融胚胎移植第5或6日行单囊胚与双囊胚移植的临床结局。方法回顾性分析2012年1月至2015年1月行囊胚玻璃化冻融移植周期678例,依据女方年龄分为21-29岁、30-34岁、35-37岁以及≥38岁,依据移植胚胎数量分为单囊胚移植和双囊胚移植,分析年龄与移植胚胎数量对临床妊娠结局的影响。结果 21-29岁、30-34岁、35-37岁3个年龄段冻融单囊胚与双囊胚移植临床妊娠率分别为:61.04%vs 78.64%,64.00%vs 75.36%和46.30%vs 79.20%,差异显著,有统计学意义(P<0.05);21-29岁、30-34岁、35-37岁3个年龄段冻融单囊胚与双囊胚移植多胎妊娠率分别为2.13%vs 47.53%,5.60%vs 49.04%以及4.00%vs 47.37%,差异极其显著(P<0.01);≥38岁两组临床妊娠率比较无统计学差异;≥38岁两组多胎妊娠率4.00%vs 28.57%,差异显著,有统计学意义(P<0.05);冻融单囊胚移植组(290例)未出现异位妊娠,双囊胚移植组(388例)异位妊娠率为1.34%;各年龄阶段单囊胚与双囊胚移植分娩率比较均无统计学差异。结论对预后良好的患者可尝试进行选择性单囊胚冷冻,降低囊胚复苏周期的多胎率和异位妊娠率,增加患者的累积妊娠率;≥38岁的高龄患者也可尝试使用选择性优质单囊胚移植方案在降低多胎和异位妊娠发生的同时增加患者的累计妊娠率。
Objective To investigate the clinical outcomes of single-blastocysts and double-blastocyst transplantation on the 5th or 6th day after vitrification and embryo transfer in patients of different ages. Methods A retrospective analysis was performed on 678 cases of vitrification and frozen-thawed implanted embryos from January 2012 to January 2015. The patients were divided into 21-29 years old, 30-34 years old, 35-37 years old and ≥38 years old according to the woman’s age. The number of embryos was divided into single blastocyst transplantation and double blastocyst transplantation, analysis of age and the number of embryos transferred on clinical pregnancy outcomes. Results The clinical pregnancy rates of frozen-thawed single blastocyst and double blastocyst in 21-29 years old, 30-34 years old and 35-37 years old were 61.04% vs 78.64%, 64.00% vs 75.36% and 46.30% vs 79.20%, the difference was statistically significant (P <0.05). The multiple pregnancy rates of frozen-thawed single-cell blastocysts and double-bladed embryos in 21-29, 30-34, 35-37 years old were 2.13 % vs 47.53%, 5.60% vs 49.04%, and 4.00% vs 47.37%, respectively (P <0.01). There was no significant difference in clinical pregnancy rates between the two groups (≥38 years old) vs 28.57% (P <0.05). There was no ectopic pregnancy in the frozen-thawed blastocyst group (290 cases), and the ectopic pregnancy rate in the double-blastocyst group (388 cases) was 1.34% There was no significant difference in the delivery rates between single-cell blastocysts and double-cell blastocysts in all age groups. Conclusions Patients with good prognosis may try selective single blastocyst freezing to reduce the rate of multiple pregnancy and ectopic pregnancy in the cycle of blastocyst resuscitation and increase the cumulative pregnancy rate of patients. Elderly patients ≥38 years of age may also try to use selective high quality The single blastocyst transfer program reduces the cumulative pregnancy rate of patients while reducing the incidence of multiple births and ectopic pregnancies.