【作者】 张顺吉；

【导师】 卢光琇；

【作者基本信息】 中南大学 ， 生殖工程， 2011， 博士

【摘要】 第一章目的本研究旨在通过分析IVF-ET中多胎妊娠发生率的相关影响因素如移植胚胎数、女方年龄、治疗周期数等,以找到最佳的移植胚胎数目方案——既能保证妊娠率又能降低多胎率。方法回顾性分析2009年1月至2010年9月在我院生殖中心行辅助生殖技术治疗的患者共17442例次,其中新鲜周期13662例次,冷冻周期3780例次。分析不同年龄(小于35岁,35-39岁,大于39岁),不同移植枚数(1枚,2枚,3枚),移植周期数患者多胎妊娠发生的差异。结果1.多胎妊娠主要发生在小于35岁的患者人群。其中绝大多数(86.47%)的双胎发生在小于35岁移植2枚、3枚的人群。三胎主要发生在移植3枚的患者人群中,其中小于35岁的患者占总三胎妊娠发生的56.54%。2.小于35岁的新鲜周期移植患者,移植1枚、2枚、3枚胚胎获得的妊娠率分别为27.22%,59.2%,57.6%,后两组差异没有显著性。总多胎率分别为3.26%,37.70%,46.83%。35-39岁的新鲜周期移植患者,移植1枚、2枚、3枚胚胎获得的妊娠率分别为14.55%,31.6%,49.5%,差异有显著性,总多胎率分别为0%,20.63%,38.89%。大于39岁患者,移植1枚、2枚、3枚胚胎获得的妊娠率分别为10.83%,14.9%,25.4%,差异有显著性,总多胎率分别为0%,11.11%,20.24%。3.小于35岁的冷冻周期移植患者,移植1枚、2枚、3枚胚胎获得的妊娠率分别为19.26%,40.4%,45.6%,后两组差异没有显著性。总多胎率分别为2.13%,16.2%,32.23%。35-39岁的冷冻周期移植患者,移植1枚、2枚、3枚胚胎获得的妊娠率分别为13.04%,24.4%,39.1%。总多胎率分别为0%,15.6%,25.77%。大于39岁的冷冻周期移植患者,移植1枚、2枚、3枚胚胎获得的妊娠率分别为5.34%,11.4%,25.4%。总多胎率分别为0%,25.0%,26.7%。结论1.小于35岁的患者是辅助生殖技术中多胎妊娠的主要发生人群,因此要控制试管婴儿多胎主要是控制35岁人群的多胎率。2.对于小于35岁的患者,可以移植2枚胚胎,这样几乎可以杜绝三胎的发生；而要降低双胎的发生,我们建议可以进一步实施选择性单胚胎移植。3.大于39岁的患者,由于着床率低,多胎发生危险性也低。第二章目的分析冷冻解冻后胚胎的存活卵裂球数与患者妊娠率、出生率、流产率的关系。方法我们分析了2007年1月到2007年12月的959例冷冻胚胎周期,其中361例获得妊娠。分析解冻后为8C,7C,6C,5C4C,3C的胚胎的妊娠率和流产率。结果1.冻后8C,7C,6C,5C,4C,3C的胚胎的总妊娠率分别为44.1%,41.0%,34.4%,23.8%,12.5%,和0%,2.冻后8C,7C,6C,5C,4C,3C的胚胎的总流产率为17.92%,19.35%,27.69%,24%,20%。结论解冻后胚胎的存活卵裂球数是影响冷冻移植周期妊娠结果的重要因素,冻后胚胎有50%的卵裂球存活的冷冻复苏标准并不是十分有效,并不能获得高的妊娠率。第三章目的比较卵裂期胚胎、囊胚行玻璃化冷冻解冻后的妊娠结果。方法回顾性分析2010年6月至2010年12月在我院生殖中心行玻璃化冷冻解冻患者共820周期的妊娠情况；其中卵裂期胚胎冷冻解冻后移植者597周期,囊胚冻融后移植67周期,卵裂期胚胎解冻后行囊胚培养后移植者156周期。结果玻璃化冷冻解冻患者共820周期,移植775周期,获得妊娠314周期,妊娠率40.52%；卵裂期胚胎冻融后移植者,囊胚冻融移植者,卵裂期胚胎解冻后行囊胚培养者复苏率分别为93.31%(1423/1525),93.28%(125/134),92.16%(835/906),妊娠率分别为38.55%(224/581),49.25%(33/67),44.88%(57/127)。开放式载杆Cryoleaf、Cryotop、Fibreplug及封闭式载杆HSV的胚胎解冻复苏率分别为93.67%,93.59%,92.88%和93.23%。胚胎着床率分别为23.14%,25.23%,22.95%和23.26%。患者胚胎移植后妊娠率分别为38.76%,38.27%,38.19%和39.43%,均无统计学差异。结论三组的玻璃化冻融复苏率无统计学差异。囊胚冷冻解冻能获得较高的妊娠率。封闭式载杆与开放式载杆能获得相同的冷冻效果。更多还原

【Abstract】 CHAPTER 1OBJECTIVE:We analyze the influences of different numbers of transferred good quanlity embryos to multiple gestation rates when in patients of different female age and cycles in order to find the optimal strategy------the number of transferred embryos can reduce the multiple gestation and stabilize the pregnancy rate.MATERIALS AND METHODS:In this retrospective study, a total of 17442 patients who conducted assisted reproductive technology was analyzed between Jan.2009 and Sept.2010. We analyze the different multiple gestation rates according to the No. of transferred embryos (1,2 and 3), the female age (<35 years old,35years old to 39 years old,>39 years old) and treatment cycles.RESULTS:1.The multiple gestation occurred mostly in the patients less than 35 years old. The most (84.7%)double gestation occurred in the patients less than 35 years old who transferred 2 or 3 embryos. The most (56.54%) triple gestation occurred in the patients less than 35 years old who transferred 3 embryos.2.The pregnancy rates of the groups that transferred 1 embryo,2 embryos,3 embryos were 27.22%,59.2%, 57.6%in women age<35,who conducted fresh cycles,there were no significant differences between the latter two groups. The multiple pregnancy rates of these groups were 3.26%,37.70%,46.83%. The pregnancy rates of the groups that transferred 1 embryo,2 embryos,3 embryos were 14.55%,31.6%,49.5%in women age between 35 to 39,who conducted fresh cycles,there were significant differences between them. The multiple pregnancy rates of these groups were 0%, 20.63%,38.89%. The pregnancy rates of the groups that transferred 1 embryo,2 embryos,3 embryos were 10.83%,14.9%,25.4%, in women age> 39,who conducted fresh cycles,there were no significant differences between later two groups. The multiple pregnancy rates of these groups were 0%,11.11%,20.24%.CONCLUSION:1. The multiple gestation occurred mostly in the patients less than 35 years old.2. We should transfer 2 embryos in the patients less than 35 to reduce triple gestation, to further reduce the double gestation, we suggest selective single embryo transfer.3. The patients more than 39 years old is insusceptible to multiple gestation because of their poor implantation rates.CHAPTER 2OBJECTIVE:To observe the differences in pregnancy rates (PRs), delivery rates, and abortion rates associated with frozen-embryo-transfer (FET)-based use of post-thawing embryos with different numbers of blastomeres.MATERIALS AND METHODS:959 FET cycles and 361 successful FET cycles performed between January 2007 and December 2007. Compare the PRs and abortion rates in post-thawing embryos with 8 blastomeres (8c),7c,6c,5c,4c,and 3c.RESULTS:1. The total PRs of post-thawing 8c,7c,6c,5c,4c, and 3c embryos were 44.1%,41.0%,34.4%,23.8%,12.5%, and 0%, respectively (p<0.05).2. The abortion rates for the transferred embryos of the 8c,7c, 6c,5c, and 4c groups were 17.92%,19.35%,27.69%,24%,20%, respectively (p<0.05).CONCLUSION:The number of blastomeres in the post-thawing embryos is an important factor influencing the occurrence of pregnancy in FET procedures; however, the criterion that post-thawing embryos with 50% intact blastomeres will lead to pregnancy may not be valid.CHAPTER 3OBJECTIVE:To compare the pregnancy after vitrification for human cleaved embryos and human blastocysts.MATERIALS AND METHODS:Retrospective analysis of 820 patients who conduct embryos vitrification from Jun.2010 to Dev.2010. Include 597 patients who conduct vitrification of cleaved embryos,67 patients who conduct vitrification of blastocysts and 156 patients whose cleaved embryos conduct blastocyst culture after warming.RESULTS:In 820 vitrified embryo thaw cycles,775 cycles were transferred,314 were obtained success pregnancy. The pregnancy rates was 40.52%. The survival rates of cleaved embryos, blastocysts and cleaved embryos conduct blastocyst culture after warming, were 93.31%(1423/1525),93.28%(125/134),92.16%(835/906) respectively, and the pregnancy rates were 38.55%(224/581),49.25%(33/67), 44.88%(57/127). The survival rates of open vitrification carrier Cryoleaf、Cryotop、Fibreplug and closed vitrification carrier HSV were 93.67%, 93.59%,92.88% and 93.23%,the implantation rates among these groups were 23.14%,25.23%,22.95% and 23.26%,and the pregnancy rates were 38.76%,38.27%,38.19% and 39.43% respectively.CONCLUSION:The survival rates of these three groups showed no statistical differences.The pregnancy rate of vitrified blastocysts are higher than those of cleaved embryos and cleaved embryos conduct blastocyst culture after warming. The closed vitrification carrier showed same freeze efficiency as the open vitrification carrier.更多还原