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目的:探讨D3仅一枚优质胚胎患者新鲜周期不同移植方案的临床结局。方法:回顾分析2014年1月至2016年12月在山东大学附属生殖医院接受体外受精-胚胎移植(IVF-ET)治疗周期的第3天(D3)仅一枚优质胚胎的3286例患者,其中2677例新鲜周期移植。根据正常受精数分为3组:A组仅有一枚正常受精胚胎;B组仅有两枚正常受精胚胎;C组大于两枚正常受精胚胎。将3组患者按移植方案再分为3组:第三天移植一枚卵裂期胚胎(D3-1组);第三天移植两枚卵裂期胚胎(D3-2组);第五天移植一枚囊胚(D5-1组)。分别比较3组患者不同移植方案的临床结局。结果:A组中,D3-1组和D5-1组的临床妊娠率、胚胎着床率、早期流产率、多胎妊娠率方面均无显著差异(P>0.05);B组中,D3-2组的临床妊娠率和多胎妊娠率均高于D3-1组(48.59%vs 33.73%,19.88%vs0,P<0.01);C组中,D3-2组的临床妊娠率和多胎妊娠率均高于D3-1组(52.88%vs 40.24%,34.34%vs 0,P<0.01),D3-2组的胚胎着床率低于D5-1组(34.95%vs 46.43%,P<0.01),D3-2组的多胎妊娠率高于D5-1组(34.34%vs 1.56%,P<0.01);D5有优质囊胚形成周期占比方面:C组高于A组和B组(68.93%vs 46.70%和56.67%,P<0.01);放弃周期率方面:C组低于A组和B组(13.79%vs 32.42%和28.0%,P<0.01)。结论:对于D3仅一枚优质胚胎的患者,移植一枚胚胎可显著降低多胎妊娠率;D5移植降低了胚胎的利用效率;D3移植两枚卵裂期胚胎比移植一枚卵裂期胚胎可获得更高的临床妊娠率;当正常受精胚胎数大于两枚时,D5移植可以获得更高的种植率。
Objective: To investigate the clinical outcome of different cycles of fresh-cycle allograft in D3 high quality embryo patients. METHODS: A retrospective analysis of 3286 patients with only one high quality embryo on day 3 (D3) of IVF-ET treatment at Affiliated Reproductive Hospital of Shandong University from January 2014 to December 2016 was performed. Among them, 2677 cases of fresh cycle transplant. According to the number of normal fertilization is divided into 3 groups: group A only one normal fertilized embryos; group B only two normal fertilized embryos; group C than two normal fertilized embryos. The three groups were further divided into three groups according to the transplantation plan: one cleavage stage embryo (D3-1 group) on the third day; two cleavage stage embryos (D3-2 group) on the third day; the fifth day Transplant a blastocyst (D5-1 group). The clinical outcomes of different transplantation plans were compared among the three groups. Results: There was no significant difference in clinical pregnancy rate, embryo implantation rate, early miscarriage rate and multiple pregnancy rate in group D3-1 and group D5-1 in group A (P> 0.05). In group B, D3-2 The clinical pregnancy rate and multiple pregnancy rate in group C were higher than those in group D3-1 (48.59% vs 33.73%, 19.88% vs0, P <0.01). In group C, the clinical pregnancy rate and multiple pregnancy rate in group D3-2 were both high The implantation rate of D3-2 group was lower than that of D5-1 group (34.95% vs 46.43%, P <0.01) in D3-1 group (52.88% vs 40.24%, 34.34% vs 0, P <0.01) (34.34% vs 1.56%, P <0.01). The proportion of high-quality blastocyst formation in D5 was higher in group C than in group A and B (68.93% vs 46.70 % And 56.67%, P <0.01). In terms of abandoning the cycle rate, the C group was lower than the A and B groups (13.79% vs 32.42% and 28.0%, P <0.01). Conclusions: Transplantation of one embryo significantly reduces the rate of multiple pregnancies in patients with D3 only one high quality embryo; D5 transplantation reduces the efficiency of embryo utilization; and D3 transplantation of two cleavage stage embryos is more likely than transplantation of one stage cleavage stage embryo Higher clinical pregnancy rate; when the number of normal fertilized embryos is more than two, D5 transplantation can achieve higher implantation rate.