影响冻融胚胎移植结局的因素分析

发布时间：2018-05-26 15:18

本文选题：冻融胚胎 + 移植　；参考：《浙江大学》2008年硕士论文

【摘要】： 背景: 体外受精-胚胎移植(In Vitro Fertilization and Embryo Transfer,IVF—ET)是指将不孕症患者夫妇的卵子与精子取出体外,在体外培养系统中受精并发育成胚胎后将胚胎植入患者宫腔内,让其种植以实现妊娠的技术。适用于输卵管性、顽固性排卵障碍、Ⅲ-Ⅳ期子宫内膜异位症、男方重度少弱精、卵巢储备功能不良等原因引起的不孕。1978年Edwards和Steptone在世界上首次成功了第一例体外受精与胚胎移植的婴儿Louis Brown,划时代地开始了人类不孕症诊治的新篇章。目前IVF-ET已成为治疗不孕症的重要手段,随着各项技术的发展,其临床妊娠率不断提高,但是这一技术一直受到妊娠后流产率高,多胎率高及相关并发症高等的困扰。而且由于促性腺激素的应用,在一个卵巢刺激周期通常可获得多个卵子,从而受精后形成的胚胎数多于一次移植胚胎的数量,大约60%的IVF-ET周期有剩余胚胎。1983年澳大利亚学者Troumon等取得人类冻融胚胎移植(Frozen-thawed embryo transfer,FET)的临床妊娠,将IVF-ET推进了一个新时代。FET是指做体外受精-胚胎移植的患者,在取卵后的新鲜周期,因卵巢过度刺激综合征或过度刺激倾向,或因宫腔因素(如内膜过薄,子宫内膜息肉等),或因孕酮过早升高,或因母体疾病需治疗不适宜移植时将胚胎冻存,待条件合适时择期移植;另外适用于促排卵周期未妊娠,有多余有价值胚胎冻存,择期内膜准备后再移植。它作为IVF-ET的补充,大大地提高了一次取卵的累积妊娠率,减少了促排卵-体外受精周期数,而且能够降低卵巢过度刺激综合征的发生率或减轻其严重程度,避免新鲜周期移植过多胚胎,减低多胎妊娠的风险,同时又能减轻患者的经济负担。FET技术已经受到广泛关注,成为目前辅助生育领域研究的热点。目的: 探讨影响冻融胚胎移植结局的相关因素。方法: 收集在浙江大学医学院附属邵逸夫医院生殖中心2007年1月1日至2007年12月31日进行冻融胚胎移植的326个周期相关资料,回顾性分析患者年龄,移植冻融胚胎质量及数量,内膜准备方式,内膜准备周期中雌激素峰值以及内膜厚度和分型对胚胎着床率、临床妊娠率、多胎率的影响。结果: 患者年龄22-43岁,平均31.1±4.1岁。326个冻融胚胎移植周期中,共移植冻融胚胎796个,平均移植胚胎数2.4±0.6个,着床胚胎235个,着床率29.5%,共移植优胚449个,平均每个冻融周期移植优胚1.4±1.1个,共165个周期获得临床妊娠,临床妊娠率为50.6%,多胎妊娠64例,多胎率为38.8%,宫外孕4例,发生率为2.4%,流产18例,流产率为10.9%。不同年龄、不同的子宫内膜厚度和形态以及移植不同数目的冻融胚胎组间临床妊娠率及临床妊娠率无显著性差异(P＞0.05);移植一个优胚组较无优胚移植组临床妊娠率显著高(P＜0.01),同时多胎率也显著升高(P＜0.01),但移植1个,2个及3个优胚组间的临床妊娠率及多胎率间无明显差异(P＞0.05)。移植周期雌激素峰值≥300pg/ml组较＜300pg/ml组临床妊娠率及临床妊娠率显著性高(P＜0.05)。促排周期、自然周期及激素替代周期冻融胚胎移植的临床妊娠率无明显差异(P＞0.05)。但促排周期的胚胎着床率较自然周期及激素替代周期显著高(P＜0.05)。结论: 在临床处理和冻融技术成熟稳定的情况下,复苏后胚胎质量是影响移植后妊娠结局的关键因素,冻融胚胎移植周期雌激素峰值达到300ng/L有利于提高胚胎的着床率及临床妊娠率。低剂量促排卵周期准备内膜冻融胚胎移植的着床率较高,可能是一种较好的内膜准备方案,但有待于更多病例的积累。
[Abstract]:Background:
In vitro fertilization and embryo transfer (In Vitro Fertilization and Embryo Transfer, IVF ET) refers to the removal of eggs and sperm from a couple of infertile couples in vitro, fertilized and developed into an embryo in an in vitro culture system to implant the embryo into the patient's uterine cavity to achieve pregnancy induced pregnancy. Hinder, stage III - IV endometriosis, severe oligospermia, poor ovarian reserve and other causes of infertility.1978 Edwards and Steptone in the world for the first time successfully the first case of in vitro fertilization and embryo transfer baby Louis Brown, epoch-making a new chapter in the diagnosis and treatment of human infertility. At present, IVF-ET has become a treatment. As an important means of infertility, with the development of various techniques, the clinical pregnancy rate is increasing, but this technique has been plagued by high rate of abortion, high multifoetus and high related complications after pregnancy. Moreover, due to the application of gonadotropin, many ovum can be obtained at the week of an ovarian stimulation, resulting in the formation of fertilization. The number of embryos is more than one embryo transfer. About 60% of the IVF-ET cycle has the remaining embryo.1983 years old Australian scholar Troumon to obtain the clinical pregnancy of human frozen thawing embryo transfer (Frozen-thawed embryo transfer, FET). IVF-ET advanced a new age.FET is a patient with an in vitro fertilization and embryo transfer. Fresh cycle, due to the tendency of ovarian hyperstimulation syndrome or excessive stimulation, or because of uterine cavity factors (such as thin endometrium, endometrium polyp, etc.), or because of progesterone premature rise, or because the mother disease is not suitable for transplantation, the embryo is frozen. As a supplement to IVF-ET, it greatly improves the cumulative pregnancy rate of an egg extraction, reduces the number of ovulation - in vitro fertilization cycles, reduces the incidence of ovarian hyperstimulation syndrome or reduces its severity, avoids the fresh embryo transfer, and reduces the wind in multiple pregnancies. At the same time, it can reduce the financial burden of patients..FET technology has attracted wide attention and has become a hot topic in the field of assisted reproductive research.
Objective:
Objective to explore the related factors affecting the outcome of frozen thawed embryo transfer.
Method:
326 cycle related data of frozen thawing embryo transfer in the reproductive center of Sir Run Run Shaw Hospital, Zhejiang University, January 1, 2007 to December 31, 2007, were collected. The age of the patients, the quality and quantity of frozen thawing embryos, the method of intimal preparation, the peak of estrogen in the endometrial preparation period, and the thickness and classification of the endometrium were reviewed. Embryo implantation rate, clinical pregnancy rate and multiple pregnancy rate.
Result:
A total of 796 frozen thawing embryos were transplanted in the.326 frozen thawing embryo transfer period of 22-43 years old and average 31.1 + 4.1 years old. The average number of transplanted embryos was 2.4 + 0.6, the implantation embryos were 235, the implantation rate was 29.5%, and the best embryos were transplanted in 1.4 + 1.1. The clinical pregnancy was obtained in a total of 165 cycles, and the clinical pregnancy rate was 50.6%. There were 64 cases of multiple pregnancy, the rate of multifoetus was 38.8%, 4 cases of ectopic pregnancy, the incidence rate was 2.4%, abortion 18 cases, the abortion rate was 10.9%. different age, the different endometrium thickness and shape, and the different number of frozen thawing embryo group had no significant difference between clinical pregnancy rate and clinical pregnancy rate (P > 0.05); the transplantation of an optimal embryo group was more than the non optimal embryo transplantation group. The rate of pregnancy was significantly higher (P < 0.01), and the multiple fetal rate was also significantly increased (P < 0.01), but there was no significant difference between the 1, 2 and 3 embryo groups (P > 0.05). The clinical pregnancy pregnancy rate and clinical pregnancy rate were higher than those in group 300pg/ml (P < 0.05). There was no significant difference in the clinical pregnancy rate of the frozen thawing embryo transfer period and the hormone replacement cycle (P > 0.05), but the implantation rate of the embryo was significantly higher than that of the natural cycle and the hormone replacement cycle (P < 0.05).
Conclusion:
The quality of the embryo after the resuscitation is the key factor affecting the outcome of the pregnancy after the clinical treatment and the frozen thawing technology. The peak of the estrogen peak of 300ng/L in the frozen thawing embryo transfer cycle is beneficial to the improvement of the implantation rate and the clinical pregnancy rate. It may be a better endometrial preparation plan, but it needs more cases.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2008
【分类号】：R714.8

【引证文献】