本文選題：凍融胚胎 + 妊娠結(jié)局�。� 參考：《河北醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：對進(jìn)行凍融胚胎移植(Frozen-thawed embryo transfer,FET)患者的各因素進(jìn)行統(tǒng)計(jì)分析，探討影響胚胎著床率、臨床妊娠率以及流產(chǎn)率的相關(guān)因素。 方法：將2012年1月1日至2013年8月31日在河北醫(yī)科大學(xué)第四醫(yī)院生殖醫(yī)學(xué)中心進(jìn)行凍融胚胎移植的498個(gè)移植周期資料作為研究對象，回顧性分析患者年齡、體重指數(shù)、內(nèi)膜準(zhǔn)備方案、移植日內(nèi)膜厚度、血雌二醇水平、移植胚胎個(gè)數(shù)、受精方式對胚胎著床率、臨床妊娠率及流產(chǎn)率的影響。 結(jié)果：總體結(jié)果：498例凍融胚胎移植周期，共移植胚胎1177個(gè)，平均每周期移植胚胎2.36±0.59個(gè)。其中著床胚胎共348個(gè)，胚胎種植率為29.57%。臨床妊娠245周期，未妊娠253周期，臨床妊娠率為49.20%，其中異位妊娠8例，異位妊娠率為3.27%，多胎妊娠4例，多胎妊娠率為1.63%，流產(chǎn)26例，流產(chǎn)率為10.61%。 1內(nèi)膜準(zhǔn)備方案：共分為四組，即自然周期組、促排卵周期組、激素替代周期組、垂體降調(diào)節(jié)激素替代周期組。自然周期組著床率明顯低于其余三組，差異有統(tǒng)計(jì)學(xué)意義，P0.05。自然周期組臨床妊娠率明顯低于其余三組，與促排卵周期組及降調(diào)節(jié)激素替代周期組比較差異有統(tǒng)計(jì)學(xué)意義，P0.05,與激素替代周期組比較差異無統(tǒng)計(jì)學(xué)意義，P0.05。四組間流產(chǎn)率比較差異無統(tǒng)計(jì)學(xué)意義，P0.05。 2內(nèi)膜厚度：內(nèi)膜厚度7mm-23mm，平均厚度為11.10±2.63mm。共分為四組，即8mm組、8-11.9mm組、12-15.9mm組及≥16mm組。四組間胚胎著床率、臨床妊娠率間差異未見統(tǒng)計(jì)學(xué)差異，P0.05。四組間流產(chǎn)率比較有統(tǒng)計(jì)學(xué)意義，P0.05。 3雌二醇：雌二醇范圍為15.88pg/ml-2338.0pg/ml。自然周期及促排卵周期，雌二醇分為110pg/ml、110-330pg/ml、330pg/ml三組。三組間著床率、臨床妊娠率、流產(chǎn)率差異均無統(tǒng)計(jì)學(xué)意義，P0.05。 激素替代周期組及垂體降調(diào)節(jié)激素替代周期組，雌二醇分為260pg/ml、260-1330pg/ml、1330pg/ml三組。三組間著床率、臨床妊娠率差異無統(tǒng)計(jì)學(xué)意義，P0.05，三組間流產(chǎn)率差異具有統(tǒng)計(jì)學(xué)意義，P0.05。 4年齡：年齡范圍20歲-47歲，平均年齡為30.39±4.58歲。分為30歲，30歲-35歲，35歲三組。35歲組胚胎著床率、臨床妊娠率均低于其余兩組，差異有統(tǒng)計(jì)學(xué)意義，P0.05。35歲組流產(chǎn)率明顯高于其余兩組，與30歲組比較差異有統(tǒng)計(jì)學(xué)意義，P0.05，與30歲-35歲組比較差異無統(tǒng)計(jì)學(xué)意義，P0.05。 5體重指數(shù)：體重指數(shù)范圍為15.63-38.57kg/m2，平均體重指數(shù)為23.27±3.51kg/m2。分為18.5kg/m2、18.5-24kg/m2、24-27kg/m2、≥27kg/m2四組。四組間胚胎著床率、臨床妊娠率、流產(chǎn)率差異均無統(tǒng)計(jì)學(xué)意義，P0.05。 6移植胚胎個(gè)數(shù)：分為移植一個(gè)、兩個(gè)、三個(gè)胚胎共三組。三組間胚胎著床率差異無統(tǒng)計(jì)學(xué)意義，P0.05。三組間臨床妊娠率差異無統(tǒng)計(jì)學(xué)意義，P0.05，移植三個(gè)胚胎組臨床妊娠率最高，為53.33%。移植一個(gè)胚胎組共妊娠10例，無流產(chǎn)發(fā)生，另兩組間流產(chǎn)率差異無統(tǒng)計(jì)學(xué)意義，P0.05。 7受精方式：分為體外受精(In vitro fertilization and embryo transfer,IVF)組及卵胞漿內(nèi)單精子注射(Intracytoplasmic single sperm injection,ICSI)組，IVF組與ICSI組著床率、妊娠率及流產(chǎn)率差異均不明顯，無統(tǒng)計(jì)學(xué)意義，P0.05。 8影響凍融胚胎移植臨床妊娠率的多因素logistic回歸分析顯示：內(nèi)膜厚度、移植胚胎個(gè)數(shù)、年齡與臨床妊娠顯著相關(guān)，內(nèi)膜準(zhǔn)備方案、體重指數(shù)、受精方式與臨床妊娠無顯著相關(guān)。 結(jié)論： 1在臨床處理、凍融水平穩(wěn)定的情況下，，年齡、子宮內(nèi)膜厚度、移植胚胎個(gè)數(shù)是影響FET妊娠結(jié)局的重要因素。 2體重指數(shù)、受精方式對妊娠結(jié)局無明顯影響。 3降調(diào)節(jié)激素替代方案能獲得較高的妊娠率，可能是一種較好的準(zhǔn)備方式，但仍需更多研究證實(shí)。 4ICSI與IVF相比凍融復(fù)蘇率、妊娠結(jié)局無顯著性差異，是治療男性不育的重要方法之一，但應(yīng)注意ICSI助孕的潛在風(fēng)險(xiǎn)，謹(jǐn)慎應(yīng)用。
[Abstract]:Objective: to analyze the factors of Frozen-thawed embryo transfer (FET) and to discuss the factors that affect the implantation rate, the clinical pregnancy rate and the abortion rate.
Methods: from January 1, 2012 to August 31, 2013, the data of 498 transplantation cycles of frozen thawing embryo transfer were carried out at the reproductive medical center of Fourth Hospital of Hebei Medical University. The age, body mass index, intimal preparation, the thickness of the endometrium, the level of estradiol, the number of transplanted embryos and the fertilization mode were analyzed. The influence of embryo implantation rate, clinical pregnancy rate and abortion rate on embryo implantation rate was analyzed.
Results: total results: 498 cases of frozen thawing embryo transfer period, 1177 embryos were transplanted, with an average of 2.36 + 0.59 embryos per cycle, including 348 implantation embryos, the embryo implantation rate was 29.57%. clinical pregnancy 245 cycles, no pregnancy 253 cycles, the clinical pregnancy rate was 49.20%, ectopic pregnancy was 8, the ectopic pregnancy rate was 3.27%, multiple pregnancy 4. The rate of multiple pregnancy was 1.63%, 26 cases were aborted, and the abortion rate was 10.61%.
1 endometrium preparation program: a total of four groups, namely, natural cycle group, ovulation cycle group, hormone replacement cycle group, pituitary descending regulation hormone replacement cycle group. The implantation rate of natural cycle group is significantly lower than the other three groups, the difference is statistically significant, the clinical pregnancy rate of P0.05. natural cycle group is significantly lower than the other three groups, and the group and descending group of ovulation stimulating cycle and descending. The difference of the hormone replacement cycle group was statistically significant, P0.05, compared with the hormone replacement cycle group, there was no statistical difference, and there was no significant difference in the abortion rate between the four groups of P0.05., P0.05.
2 intimal thickness: the thickness of the endometrium 7mm-23mm and the average thickness of 11.10 + 2.63mm. were divided into four groups, that is, group 8mm, group 8-11.9mm, 12-15.9mm and 16mm. There was no statistical difference between the four groups of embryo implantation rate and clinical pregnancy rate. The abortion rate between the four groups of P0.05. four groups was statistically significant, P0.05.
3 estradiol: the estradiol range is 15.88pg/ml-2338.0pg/ml. natural cycle and ovulation cycle. Estradiol is divided into 110pg/ml, 110-330pg/ml, 330pg/ml three groups. There is no significant difference between the three groups of implantation rates, clinical pregnancy rate, and abortion rate, P0.05.
Hormone replacement cycle group and pituitary descending regulation hormone replacement cycle group, estradiol was divided into 260pg/ml, 260-1330pg/ml, 1330pg/ml three groups. There was no statistically significant difference in the rate of implantation between the three groups and the clinical pregnancy rate, P0.05, the difference of abortion rate between the three groups was statistically significant, P0.05.
4 age: age range of 20 years old -47 years, the average age is 30.39 + 4.58 years old. It is divided into 30 years old, 30 year old -35 years old, 35 year old and three group.35 age group embryo implantation rate. The clinical pregnancy rate is lower than the other two groups, the difference is statistically significant higher than the other two groups, compared with the 30 year group, the difference is statistically significant, P0.05, and 30 year -35 years old group. The difference was not statistically significant, P0.05.
5 body mass index: the body mass index range was 15.63-38.57kg/m2, the average body mass index was 23.27 + 3.51kg/m2., 18.5kg/m2,18.5-24kg/m2,24-27kg/m2 and four groups. Four groups of embryo implantation rate, clinical pregnancy rate and abortion rate were not statistically significant, P0.05.
6 the number of transplanted embryos, divided into one, two and three embryos, three groups. There was no significant difference in the implantation rate between the three groups. There was no significant difference in the clinical pregnancy rate between the groups of P0.05. three, P0.05, the highest clinical pregnancy rate of the three embryo transfer groups was in the group of 53.33%. transplantation, and there were 10 cases of pregnancy without abortion, and two groups between the other two groups. There was no significant difference in the rate of abortion, P0.05.
7 methods of fertilization were divided into group In vitro fertilization and embryo transfer, IVF, and intracytoplasmic sperm injection (Intracytoplasmic single sperm injection, ICSI).
8 the multiple factor Logistic regression analysis of the clinical pregnancy rate of frozen thawing embryo transfer showed that the thickness of the endometrium, the number of transplanted embryos, age were significantly related to the clinical pregnancy, and the intimal preparation, body mass index, and fertilization were not significantly related to the clinical pregnancy.
Conclusion:
1 age, endometrial thickness and number of embryos transferred are important factors affecting the pregnancy outcome of FET.
2 body mass index and fertilization did not significantly affect pregnancy outcome.
3 the hormone replacement therapy can achieve higher pregnancy rate. It may be a better preparation method, but more studies need to be done.
There is no significant difference in the pregnancy outcome between 4ICSI and IVF. There is no significant difference in pregnancy outcome. It is one of the important methods for the treatment of male infertility. However, the potential risk of ICSI assisted pregnancy should be paid attention to, and it should be carefully applied.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R714.8

【引證文獻(xiàn)】

相關(guān)碩士學(xué)位論文 前1條

1 袁巧娜;不同激素替代周期在凍融胚胎移植中的應(yīng)用比較[D];新疆醫(yī)科大學(xué);2016年

本文編號：1929703