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目的:探讨新鲜周期选择性移植单个囊胚(elective single blastocyst transfer,eSBT)对降低多胎妊娠风险的作用。方法:回顾性分析新鲜囊胚移植患者的病历资料,其中可供移植的囊胚数≥2个的患者中,选择性单个囊胚移植周期159个(eSBT组),双囊胚移植周期118个(double blastocysttransfer,DBT组),分析比较eSBT组与DBT组患者的一般情况、超促排卵情况、胚胎发育情况和妊娠结局。结果:①采用序贯囊胚培养法,共培养优质胚胎1 040枚,形成囊胚781枚,囊胚形成率75.09%。②患者一般情况、超促排卵和胚胎发育情况组间均无统计学差异(P>0.05),eSBT组与DBT组临床妊娠率(52.83%vs 57.63%)、流产率(4.76%vs 10.29%)未见明显差异(P>0.05),eSBT组种植率显著高于DBT组(54.09%vs 37.71%,P<0.01),多胎率显著低于DBT组(2.38%vs 30.88%,P<0.01)。③按年龄<30岁、30～34岁、35～38岁分段后,eSBT组各年龄段间临床妊娠率均无明显降低(P>0.05),多胎率均显著降低(P<0.01)。结论:新鲜囊胚移植患者选择性单个囊胚移植能在保证较高临床妊娠率的同时,有效降低多胎妊娠的风险。
Objective: To explore the effect of elective single blastocyst transfer (eSBT) on the risk of multiple pregnancy. Methods: The clinical data of fresh blastocysts were retrospectively analyzed. Among them, there were 159 single blastocysts (eSBT group), 118 double-blastocysts (double blastocysttransfer, DBT group), analysis and comparison of eSBT group and DBT group patients general situation, super-ovulation, embryonic development and pregnancy outcomes. Results: ① Sequential blastocyst culture method was used to co-culture 1 040 high quality embryos, 781 blastocysts were formed, the blastocyst formation rate was 75.09%. The clinical pregnancy rate (52.83% vs 57.63%) and abortion rate (4.76% vs 10.29%) in eSBT group and DBT group were not significantly different between the two groups (P> 0.05) The implantation rate of eSBT group was significantly higher than that of DBT group (54.09% vs 37.71%, P <0.01), and the multiple birth rate was significantly lower than that of DBT group (2.38% vs 30.88%, P <0.01). ③According to the age <30 years old, 30 ~ 34 years old, 35 ~ 38 years old, the eSBT group had no significant decrease in clinical pregnancy rate (P> 0.05) and multiple birth rate (P <0.01). Conclusion: The selective single blastocyst transplantation in patients with fresh blastocysts can effectively reduce the risk of multiple pregnancy while ensuring a high clinical pregnancy rate.