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目的探讨瘢痕子宫患者体外受精-胚胎移植(in vitrofertilization and embryo transfer,IVF-ET)中行单囊胚移植的妊娠结局。方法接受体外受精(in vitro fertilization,IVF)/卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)瘢痕子宫不孕患者269例,随机分为单囊胚移植组92例,单卵裂期胚胎移植组74例,双卵裂期胚胎移植组103例,3组均采用黄体中期短效长方案进行控制性促排卵,取卵后常规行IVF/ICSI和体外培养,取卵后第3天(D3)单卵裂期胚胎移植组选择1个、双卵裂期胚胎移植组选择2个优质卵裂期胚胎移植,单囊胚移植组取卵后第5天(D5)移植1个优质囊胚。比较3组获卵数、MⅡ卵数、2PN数、D3可利用胚胎数、临床妊娠率、异位妊娠率、种植率、多胎率、早期流产率。结果 3组基础卵泡刺激素水平、促性腺激素用量、促性腺激素应用时间、移植日子宫内膜厚度比较差异均无统计学意义(P>0.05);单卵裂期胚胎移植组获卵数[(9.04±3.52)个]、MⅡ卵数[(7.21±2.02)个]、2PN数[(5.83±2.11)个]、D3可利用胚胎数[(3.65±1.44)个]低于单囊胚移植组[(11.26±5.47)、(9.26±3.15)、(7.25±3.19)、(5.61±2.52)个]和双卵裂期胚胎移植组[(10.93±4.98)、(8.95±3.02)、(7.02±3.01)、(5.30±2.11)个](P<0.05),单囊胚移植组与双卵裂期胚胎移植组比较差异无统计学意义(P>0.05);单囊胚移植组、双卵裂期胚胎移植组临床妊娠率(64.13%、60.19%)高于单卵裂期胚胎移植组(43.24%)(P<0.05),单囊胚移植组与双卵裂期胚胎移植组比较差异无统计学意义(P>0.05);单囊胚移植组种植率(64.13%)高于单卵裂期胚胎移植组(43.24%)和双卵裂期胚胎移植组(43.20%)(P<0.05),单卵裂期胚胎移植组与双卵裂期胚胎移植组比较差异无统计学意义(P>0.05);单囊胚移植组、单卵裂期胚胎移植组未出现多胎妊娠,双卵裂期胚胎移植组多胎妊娠率为40.32%;3组均无异位妊娠,3组早期流产率比较差异无统计学意义(P>0.05)。结论 IVF-ET中瘢痕子宫患者选择单囊胚移植可明显提高胚胎种植率,降低多胎妊娠率,有效维持总体临床妊娠率。
Objective To investigate the pregnancy outcomes of single-blastocyst transplantation in in vitro fertilization-embryo transfer (IVF-ET) in patients with uterine scar. Methods 269 cases of uterine infertility with intracytoplasmic sperm injection (IVF) and intracytoplasmic sperm injection (ICSI) were randomly divided into single blastocyst transplantation group (n = 92), single cleavage stage embryo 74 cases of transplantation group, 103 cases of double cleavage embryo transfer group, 3 groups were using the luteal medium short-term long-term regimen for ovulation induction, routine IVF / ICSI after ovulation and in vitro culture, the first 3 days after ovulation D3) single blastomere stage embryo transfer group selected 1, double cleavage stage embryo transfer group selected 2 high quality cleavage stage embryo transfer, single blastocyst transplantation group 5 days after ovulation (D5) transplantation 1 high quality blastula . The number of oocytes retrieved, number of MII oocytes, number of 2PN, number of embryos available for D3, clinical pregnancy rate, ectopic pregnancy rate, implantation rate, multiple birth rate and early miscarriage rate were compared. Results There were no significant differences in the levels of basic follicle-stimulating hormone, gonadotrophin, gonadotrophin application time, and endometrial thickness at the transplantation day (P> 0.05). The number of oocytes in the single-cleavage stage embryo transfer group [ (9.04 ± 3.52)], the number of MⅡ oocytes [(7.21 ± 2.02)] and the number of 2PN [(5.83 ± 2.11) ([(11.26 ± 5.47), (9.26 ± 3.15), (7.25 ± 3.19), (5.61 ± 2.52)] and double cleavage embryo transfer group [(10.93 ± 4.98), (8.95 ± 3.02), (7.02 ± 3.01), (5.30 ± 2.11), respectively (P <0.05). There was no significant difference between single blastocyst transplantation group and double cleavage stage embryo transfer group (P> 0.05) The clinical pregnancy rates (64.13%, 60.19%) in the group with cleaved embryo transfer were higher than those in the group with single cleavage embryo transfer (43.24%) (P <0.05). There was no difference between the single blastocyst group and the double cleavage stage embryo group (P> 0.05). The implantation rate of the single blastocyst transplantation group (64.13%) was higher than that of the single cleavage stage embryo transfer group (43.24%) and the double cleavage stage embryo transfer group (43.20% , Single cleavage embryo transfer group and double cleavage embryo transfer group differences Statistical significance (P> 0.05). There was no multiple pregnancy in the single blastocyst transplantation group and 40.32% in the double cleavage stage embryo transfer group. There was no ectopic pregnancy in the 3 groups There was no significant difference in early abortion rate (P> 0.05). Conclusion The selection of single blastocyst transplantation in patients with uterine scar in IVF-ET can significantly improve embryo implantation rate, reduce the rate of multiple pregnancy, and effectively maintain the overall clinical pregnancy rate.