摘要
目的探讨减少移植胚胎数量对于年龄≥35岁妇女体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)临床结局的影响。方法回顾性分析2009年1月—2015年12月期间在本中心接受新鲜周期胚胎移植且年龄≥35岁患者的临床资料,每名患者只纳入第一个取卵周期。取卵后第3日(D3)可移植胚胎数均>3个但选择移植2个胚胎者为研究组,共2 361个周期;按照1︰1对年龄、体质量指数(BMI)、基础卵泡刺激素(FSH)水平等进行配比选择移植3个胚胎者为对照组,共计2 361个周期。比较研究组和对照组患者的基线数据和临床结局。根据女方年龄将研究组和对照组再分为35～37岁组、38～40岁组和>40岁组,比较不同年龄亚组减少胚胎移植数量对临床结局的影响。结果患者年龄、不孕年限、BMI、基础FSH水平、促性腺激素(Gn)用量、使用时间等组间差异均无统计学意义(P>0.05);研究组与对照组相比,临床妊娠率、活产率、流产率,差异均无统计学意义(P>0.05);研究组着床率(13.55%)显著高于对照组(10.36%,P<0.001);研究组多胎妊娠率(19.18%)、异位妊娠率(6.15%)、早产率(13.62%)均显著低于对照组(24.56%、10.8%、24.7%;P=0.03、P=0.006、P=0.001)。研究组新生儿的胎龄[(37.9±2.0)周]及平均出生体质量[(3 110.9±653.9) g]均显著大于对照组[(37.3±2.4)周,(2 957.7±656.1) g],差异有统计学意义(P=0.002,P=0.004)。在35～37岁组、38～40岁组、>40岁组中,研究组与对照组的临床妊娠率、活产率、流产率差异均无统计学意义(P>0.05),>40岁研究组多胎妊娠率(6.41%)显著低于对照组(18.18%,P=0.035)。结论对于年龄≥35岁妇女减少移植胚胎数量并不降低临床妊娠率和活产率,同时显著降低多胎妊娠率,改善妊娠结局。
ObjectiveTo study the effect of decreasing the number of embryos transferred on pregnancy outcomes in women aged ≥35 years.
MethodsA retrospective study was performed in infertile women aged≥35 years undergoing fresh transfer cycles, who were treated in our center between January 2009 and December 2015. After egg retrieval on day 3, the patients with more than 3 embryos who were transferred 2 embryos were defined as study group, which contained 2 361 cycles. Each IVF cycles were matched to the control cycles by age, body mass index （BMI） and basal follicle stimulating hormone （FSH） level. Control group which were transferred 3 embryos had a total of 2 361 cycles. The clinical outcomes in the two groups were analyzed and compared. The study and control groups were divided into three age groups, respectively, namely 35-37 years group, 38-40 years group, and 〉40 years group. The effect of decreasing the number of embryo transferred on pregnancy outcomes were compared between different age groups.
ResultsThere were no significantly differences in terms of patients age, duration of infertility, BMI, basal FSH level, total gonadotrophin （Gn） used dosage and Gn stimulation days （P〉0.05）. Between study group and control group, there were no major difference in the prevalence of clinical pregnancy rate, abortion rate and live birth rate （P〉0.05）. The incidence of implantation rate （13.55%） in study group was significantly higher than that in control group （10.36%, P〈0.001）. The prevalence of multiple pregnancy rate （19.18%）, ectopic pregnancy rate （6.15%） and premature delivery rate （13.62%） in study group were evidently lower than those in control group （24.56%, 10.8%, 24.7%; P=0.03, P=0.006, P=0.001）. The analysis of live born children’s basic characteristic showed that the mean gestational age [（37.9±2.0） weeks] in study group was significantly longer than that in control group [（37.3±2.4） weeks, P=0.002]. The mean neonatal weight in study group [（3 110.9±653.9） g] was significantly heavier than that in control group [（2 957.7±656.1） g, P=0.004]. In patients aged 35-37 years, 38-40 years and 〉40 years, there were no significantly differences in clinical pregnancy rate, abortion rate and live birth rate between study group and control group （P〉0.05）. The prevalence of multiple pregnancy rate （6.41%） in study group was evidently lower than control group （18.18%, P=0.035）.
ConclusionFor women≥35 years old reducing the number of embryos transferred does not effect clinical pregnancy rate and live birth rate, but can reduce the occurrence of multiple pregnancy rate and improve the clinical outcome of the patients.
作者
杨璞玉
马彩虹
陈立雪
陶立元
李蓉
刘平
乔杰
Yang Puyu;Ma Caihong;Chen Lixue;Tao Liyuan;Li Rong;Liu Ping;Qiao Jie(Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Research Center of Clinical Epidemiology,Peking University Third Hospital,Beijing 100191,China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2018年第10期831-836,共6页
Chinese Journal of Reproduction and Contraception
关键词
体外受精-胚胎移植(IVF-ET)
高龄
临床妊娠率
多胎妊娠率
活产率
In vitro fertilization and embryo transfer （IVF-ET）
Advanced age
Clinical pregnancy rate
Multiple pregnancy rate
Live birth rate
