2008~2017年体外受精/卵胞浆内单精子显微注射周期取消新鲜胚胎移植的原因构成与变化

doi:10.6040/j.issn.1671-7554.0.2018.512

摘要/Abstract

摘要： 目的分析2008~2017年10年间行体外受精(IVF)/卵胞浆内单精子显微注射(ICSI)周期取消新鲜胚胎移植的原因构成及变化。方法回顾性分析2008年至2017年取消新鲜胚胎移植的17 601个IVF/ICSI周期,其中2008年至2012年3 018个周期、2013年至2017年14 583个周期,根据取消原因分为预防卵巢过度刺激综合征(OHSS)、注射人绒毛膜促性腺激素(HCG)日孕酮值升高、子宫内膜因素、胚胎因素、输卵管积水及其他因素,分析10年间取消鲜胚移植的原因构成比,并进一步按女性不同年龄组(≥35岁和<35岁)及不同用药方案进行分层分析。结果 IVF/ICSI取消新鲜胚胎移植的主要原因是OHSS风险,近10年在各年龄组发生率均有上升趋势。≥35岁患者取消移植的主要原因是胚胎因素,<35岁患者取消移植的主要原因是OHSS风险。因输卵管积水取消鲜胚移植的比例近10年在各年龄组中均有增加。长方案、拮抗剂方案及超长方案取消鲜胚移植的主要原因是预防OHSS,短方案、微刺激方案主要原因是胚胎因素。结论目前IVF/ICSI取消鲜胚移植的主要原因是OHSS风险,其次为胚胎因素、内膜因素。年龄越大,胚胎原因取消移植所占比例越高。有效预防卵巢高反应、提高高龄女性胚胎质量、积极控制盆腔炎症是降低鲜胚移植取消率、改善辅助生殖技术妊娠结局的有效措施。

关键词: 鲜胚移植, 全胚冷冻, 卵巢过度刺激综合征, 子宫内膜, 孕酮

Abstract: Objective To analyze the proportion and changes of causes resulting in the cancellation of fresh embryo transfer of in vitro fertilization(IVF)/intracytoplasmic sperm injection(ICSI)from 2008 to 2017 in the Reproductive Hospital Affiliated to Shandong University. Methods A retrospective analysis was performed among 17 601 cycles of IVF/ICSI fresh embryo transfer cancellation, including 3 018 cycles during 2008 and 2012, and 14 583 cycles during 2013 and 2017. The causes of cancellation included ovarian hyperstimulation syndrome(OHSS), high level of serum progesterone, endometrial factors, poor embryo quality, hydrosalpinx, and others. Further analysis was performed 山东大学学报 (医学版)56卷9期 -范华蕊,等. 2008~2017年体外受精/卵胞浆内单精子显微注射周期取消新鲜胚胎移植的原因构成与变化 \=-according to the female age(<35 years and ≥35 yrs)and different protocols. Results The major cause for cancellation was OHSS risk, which showed an increasing trend in all age groups in the past 10 years. For women ≥35 years, the dominant cause was poor embryo quality, whereas for women <35 years, the major cause was OHSS risk. An obvious increase was observed in the proportion of hydrosalpinx in all age groups in the past 10 years. For long, GnRH antagonist and ultra-long GnRHa protocols, the prominent cause for cancellation was OHSS risk. For short, mini-stimulation protocols, the major cause was poor embryo quality. Conclusion OHSS risk was the commonest cause for cancellation of fresh embryo transfer, followed by poor embryo quality and endometrial factors. Embryo quality was a challenge for female of advanced aged. Effective methods could be considered to reduce the rate of cancellation, such as preventing ovarian hyperresponsiveness, improving embryo quality, and controlling pelvic inflammation.

Key words: Fresh embryo transfer, Embryos freezing, Ovarian hyperstimulation syndrome, Endometrium, Progesterone

中图分类号:

R711.6

范华蕊,张洋,郭情情,李福侠,唐蓉,盛燕,丁玲玲,秦莹莹. 2008~2017年体外受精/卵胞浆内单精子显微注射周期取消新鲜胚胎移植的原因构成与变化[J]. 山东大学学报 (医学版), 2018, 56(9): 47-53.

FAN Huarui, ZHANG Yang, GUO Qingqing, LI Fuxia, TANG Rong, SHENG Yan, DING Lingling, QIN Yingying. Analysis on the proportion and changes of causes for cancellation of fresh embryo transfer from 2008 to 2017[J]. Journal of Shandong University (Health Sciences), 2018, 56(9): 47-53.

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