摘要
目的:探讨潜在的可能导致体外授精/卵胞质内单精子注射-胚胎移植(IVF/ICSIET)技术单卵双胎(MZT)高发生率的因素及其可能机制。方法:回顾性分析行IVF/ICSI-ET的2 885个周期,其中新鲜胚胎移植2 184个周期(常规IVF-ET周期1 473个,ICSI周期711个)和冻融胚胎移植(FET)周期701个,统计各个周期MZT妊娠的发生率,并分析可能影响其发生的相关因素。结果:在2 885个周期中临床妊娠1 102例,多胎妊娠的发生率为20.78%(229/1 102),其中MZT(双绒毛膜双胎及单绒毛膜双胎)妊娠20例,占临床妊娠的1.81%(20/1 102),占多胎的8.73%(20/229)。MZT中单卵双绒毛膜双胎5例,占MZT的25%(5/20),单卵单绒毛膜双胎15例,占MZT的75%(15/20)。ICSI中MZT的发生率为1.76%(5/284),高于常规IVF-ET周期(1.56%,9/575),但无统计学差异(P>0.05)。FET组701个周期中临床妊娠243个周期,多胎34例,MZT 6例,占多胎发生率的17.65%(6/34);新鲜移植的2 184个周期中临床妊娠859个周期,多胎195例,MZT 14个周期,占多胎发生的7.18%(14/195),FET组和新鲜周期移植组间多胎率有统计学差异(P<0.05)。囊胚移植204个周期中妊娠95例,多胎12例,MZT3例,占多胎发生的25%(3/12),非囊胚移植2 681个周期中妊娠1 007例,多胎217例,MZT 17例,占多胎发生的7.83%(17/217),囊胚移植组与非囊胚移植组间多胎率有统计学差异(P<0.05)。冻融囊胚移植发生MZT的几率显著高于冻融非囊胚移植(P<0.05)。IVF-ET中MZT妊娠与非MZT妊娠患者的年龄、促排卵方案、促排卵天数、促性腺激素(Gn)剂量与时间、优质胚胎数、移植胚胎数之间均无统计学差异(P>0.05)。结论:MZT的发生率IVF/ICSI-ET明显高于自然妊娠;冻融囊胚移植明显高于冻融非囊胚移植,这可能与体外培养条件和冷冻复苏技术的应用有关,使其透明带硬度有所增加,致使囊胚在孵出时较易嵌顿,从而导致了MZT的发生。单纯显微授精技术不会明显增加MZT的发生率。
Objective： To investigate the monozygotic twinning （MZT） pregnancy occurred in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer （IVF/ICSI-ET） and analyze the potential possible factors which may lead to high incidence of MZT in IVF/ICSI-ET. Methods： A retrospective study was performed on women with MZT pregnancy in 1 473 conventional IVF-ET cycles, in 711 ICSI cycles and in 701 frozen-thawed embryo transfer （FET） cycles. The incidence rate of MZT in IVF/ICSI-ETs was investigated, and relevant factors that may affect its occurrence were analyzed. Results： The number of gestational sac which was greater than the number of embryos transferred （double-chorionic twins） or a single gestation with the intracapsular two germs and heart tube pulsation （monochorionic twins） were diagnosed as MZT. There were 1 102 clinical pregnancies of 2 885 IVF/ICSI-ET cycles in our center, the multiple pregnancy rate was 20.78%, of which 20 cases of MZT pregnancies, accounting for 1.81% of clinical pregnancies, accounting for 8.37% of multiple births. Five cases of MZT were monozygotic pairs chorionic twins, accounting for 25% of the MZT, 15 cases were monozygotic MZT, accounting for 75% of the MZT. The incidence rate of MZT between conven- tional IVF-ET cycles and ICSI cycles was not significantly different. There were 243 clinical pregnancies of FET, 34 cases multiple births, 6 cases of MZT, accounting for 17.65% of the incidence of multiple births. There were 859 clinical pregnancies in the transplantation of the fresh cycles, 195 cases of multiple births, 14 cycles of MZT, multiple births occurred in 7.18%. There were significant differences between routine IVF group and ICSI group （P〈0.05）. Among 204 cycles of blastocyst transfer, 95 cases were pregnant, 12 cases of multiple births, 3 cases of MZT, accounting for 25% of multiple births, among 1 007 pregnancy cases in non-blastocyst transfer, 217 cases of multiple births, 17 cases of MZT, accounting for 7.83% of the occurrence of multiple births in both groups, with a significant difference （P〈0.05）. Compared with the probability of occurrence of MZT wassignificantly higher in frozen-thawed blastocyst transfer than in frozen-thawed non-blastocyst transfer （P〈0.05）. There were no significant differences between MZT and the age of ovulation induction, ovulation days, the dose and the duration of gonadotropin （Gn） and the number of embryos （P〉0.05）. Conclusion： The incidence rate of MZTs in IVF/ICSI-ET cycles was significantly higher than that in natural pregnancy. This may be related to the application of in vitro culture conditions and cryopreservation techniques. Blastocyst transfer in FET transfer can be significantly increased incidence of MZT, may be the embryos cultured in vitro time, making it the zona pellucida hardness has increased, resulting in blastocyst hatching easier incarcerated, resulting in the occurrence of MZT. Simple microscopic insemination technology and frozen-thawed procedure will not significantly in- crease the incidence of MZT.
出处
《生殖与避孕》
CAS
CSCD
2014年第1期27-35,共9页
Reproduction and Contraception
