本文選題：凍融胚胎 + 移植�。� 參考：《浙江大學》2008年碩士論文

【摘要】： 背景: 體外受精-胚胎移植(In Vitro Fertilization and Embryo Transfer,IVF—ET)是指將不孕癥患者夫婦的卵子與精子取出體外,在體外培養(yǎng)系統(tǒng)中受精并發(fā)育成胚胎后將胚胎植入患者宮腔內(nèi),讓其種植以實現(xiàn)妊娠的技術(shù)。適用于輸卵管性、頑固性排卵障礙、Ⅲ-Ⅳ期子宮內(nèi)膜異位癥、男方重度少弱精、卵巢儲備功能不良等原因引起的不孕。1978年Edwards和Steptone在世界上首次成功了第一例體外受精與胚胎移植的嬰兒Louis Brown,劃時代地開始了人類不孕癥診治的新篇章。目前IVF-ET已成為治療不孕癥的重要手段,隨著各項技術(shù)的發(fā)展,其臨床妊娠率不斷提高,但是這一技術(shù)一直受到妊娠后流產(chǎn)率高,多胎率高及相關(guān)并發(fā)癥高等的困擾。而且由于促性腺激素的應用,在一個卵巢刺激周期通常可獲得多個卵子,從而受精后形成的胚胎數(shù)多于一次移植胚胎的數(shù)量,大約60%的IVF-ET周期有剩余胚胎。1983年澳大利亞學者Troumon等取得人類凍融胚胎移植(Frozen-thawed embryo transfer,FET)的臨床妊娠,將IVF-ET推進了一個新時代。FET是指做體外受精-胚胎移植的患者,在取卵后的新鮮周期,因卵巢過度刺激綜合征或過度刺激傾向,或因?qū)m腔因素(如內(nèi)膜過薄,子宮內(nèi)膜息肉等),或因孕酮過早升高,或因母體疾病需治療不適宜移植時將胚胎凍存,待條件合適時擇期移植;另外適用于促排卵周期未妊娠,有多余有價值胚胎凍存,擇期內(nèi)膜準備后再移植。它作為IVF-ET的補充,大大地提高了一次取卵的累積妊娠率,減少了促排卵-體外受精周期數(shù),而且能夠降低卵巢過度刺激綜合征的發(fā)生率或減輕其嚴重程度,避免新鮮周期移植過多胚胎,減低多胎妊娠的風險,同時又能減輕患者的經(jīng)濟負擔。FET技術(shù)已經(jīng)受到廣泛關(guān)注,成為目前輔助生育領(lǐng)域研究的熱點。 目的: 探討影響凍融胚胎移植結(jié)局的相關(guān)因素。 方法: 收集在浙江大學醫(yī)學院附屬邵逸夫醫(yī)院生殖中心2007年1月1日至2007年12月31日進行凍融胚胎移植的326個周期相關(guān)資料,回顧性分析患者年齡,移植凍融胚胎質(zhì)量及數(shù)量,內(nèi)膜準備方式,內(nèi)膜準備周期中雌激素峰值以及內(nèi)膜厚度和分型對胚胎著床率、臨床妊娠率、多胎率的影響。 結(jié)果: 患者年齡22-43歲,平均31.1±4.1歲。326個凍融胚胎移植周期中,共移植凍融胚胎796個,平均移植胚胎數(shù)2.4±0.6個,著床胚胎235個,著床率29.5%,共移植優(yōu)胚449個,平均每個凍融周期移植優(yōu)胚1.4±1.1個,共165個周期獲得臨床妊娠,臨床妊娠率為50.6%,多胎妊娠64例,多胎率為38.8%,宮外孕4例,發(fā)生率為2.4%,流產(chǎn)18例,流產(chǎn)率為10.9%。不同年齡、不同的子宮內(nèi)膜厚度和形態(tài)以及移植不同數(shù)目的凍融胚胎組間臨床妊娠率及臨床妊娠率無顯著性差異(P＞0.05);移植一個優(yōu)胚組較無優(yōu)胚移植組臨床妊娠率顯著高(P＜0.01),同時多胎率也顯著升高(P＜0.01),但移植1個,2個及3個優(yōu)胚組間的臨床妊娠率及多胎率間無明顯差異(P＞0.05)。移植周期雌激素峰值≥300pg/ml組較＜300pg/ml組臨床妊娠率及臨床妊娠率顯著性高(P＜0.05)。促排周期、自然周期及激素替代周期凍融胚胎移植的臨床妊娠率無明顯差異(P＞0.05)。但促排周期的胚胎著床率較自然周期及激素替代周期顯著高(P＜0.05)。 結(jié)論: 在臨床處理和凍融技術(shù)成熟穩(wěn)定的情況下,復蘇后胚胎質(zhì)量是影響移植后妊娠結(jié)局的關(guān)鍵因素,凍融胚胎移植周期雌激素峰值達到300ng/L有利于提高胚胎的著床率及臨床妊娠率。低劑量促排卵周期準備內(nèi)膜凍融胚胎移植的著床率較高,可能是一種較好的內(nèi)膜準備方案,但有待于更多病例的積累。
[Abstract]:Background:
In vitro fertilization and embryo transfer (In Vitro Fertilization and Embryo Transfer, IVF ET) refers to the removal of eggs and sperm from a couple of infertile couples in vitro, fertilized and developed into an embryo in an in vitro culture system to implant the embryo into the patient's uterine cavity to achieve pregnancy induced pregnancy. Hinder, stage III - IV endometriosis, severe oligospermia, poor ovarian reserve and other causes of infertility.1978 Edwards and Steptone in the world for the first time successfully the first case of in vitro fertilization and embryo transfer baby Louis Brown, epoch-making a new chapter in the diagnosis and treatment of human infertility. At present, IVF-ET has become a treatment. As an important means of infertility, with the development of various techniques, the clinical pregnancy rate is increasing, but this technique has been plagued by high rate of abortion, high multifoetus and high related complications after pregnancy. Moreover, due to the application of gonadotropin, many ovum can be obtained at the week of an ovarian stimulation, resulting in the formation of fertilization. The number of embryos is more than one embryo transfer. About 60% of the IVF-ET cycle has the remaining embryo.1983 years old Australian scholar Troumon to obtain the clinical pregnancy of human frozen thawing embryo transfer (Frozen-thawed embryo transfer, FET). IVF-ET advanced a new age.FET is a patient with an in vitro fertilization and embryo transfer. Fresh cycle, due to the tendency of ovarian hyperstimulation syndrome or excessive stimulation, or because of uterine cavity factors (such as thin endometrium, endometrium polyp, etc.), or because of progesterone premature rise, or because the mother disease is not suitable for transplantation, the embryo is frozen. As a supplement to IVF-ET, it greatly improves the cumulative pregnancy rate of an egg extraction, reduces the number of ovulation - in vitro fertilization cycles, reduces the incidence of ovarian hyperstimulation syndrome or reduces its severity, avoids the fresh embryo transfer, and reduces the wind in multiple pregnancies. At the same time, it can reduce the financial burden of patients..FET technology has attracted wide attention and has become a hot topic in the field of assisted reproductive research.
Objective:
Objective to explore the related factors affecting the outcome of frozen thawed embryo transfer.
Method:
326 cycle related data of frozen thawing embryo transfer in the reproductive center of Sir Run Run Shaw Hospital, Zhejiang University, January 1, 2007 to December 31, 2007, were collected. The age of the patients, the quality and quantity of frozen thawing embryos, the method of intimal preparation, the peak of estrogen in the endometrial preparation period, and the thickness and classification of the endometrium were reviewed. Embryo implantation rate, clinical pregnancy rate and multiple pregnancy rate.
Result:
A total of 796 frozen thawing embryos were transplanted in the.326 frozen thawing embryo transfer period of 22-43 years old and average 31.1 + 4.1 years old. The average number of transplanted embryos was 2.4 + 0.6, the implantation embryos were 235, the implantation rate was 29.5%, and the best embryos were transplanted in 1.4 + 1.1. The clinical pregnancy was obtained in a total of 165 cycles, and the clinical pregnancy rate was 50.6%. There were 64 cases of multiple pregnancy, the rate of multifoetus was 38.8%, 4 cases of ectopic pregnancy, the incidence rate was 2.4%, abortion 18 cases, the abortion rate was 10.9%. different age, the different endometrium thickness and shape, and the different number of frozen thawing embryo group had no significant difference between clinical pregnancy rate and clinical pregnancy rate (P > 0.05); the transplantation of an optimal embryo group was more than the non optimal embryo transplantation group. The rate of pregnancy was significantly higher (P < 0.01), and the multiple fetal rate was also significantly increased (P < 0.01), but there was no significant difference between the 1, 2 and 3 embryo groups (P > 0.05). The clinical pregnancy pregnancy rate and clinical pregnancy rate were higher than those in group 300pg/ml (P < 0.05). There was no significant difference in the clinical pregnancy rate of the frozen thawing embryo transfer period and the hormone replacement cycle (P > 0.05), but the implantation rate of the embryo was significantly higher than that of the natural cycle and the hormone replacement cycle (P < 0.05).
Conclusion:
The quality of the embryo after the resuscitation is the key factor affecting the outcome of the pregnancy after the clinical treatment and the frozen thawing technology. The peak of the estrogen peak of 300ng/L in the frozen thawing embryo transfer cycle is beneficial to the improvement of the implantation rate and the clinical pregnancy rate. It may be a better endometrial preparation plan, but it needs more cases.
【學位授予單位】：浙江大學
【學位級別】：碩士
【學位授予年份】：2008
【分類號】：R714.8

【引證文獻】

相關(guān)碩士學位論文 前1條

1 王宏鋒;降調(diào)節(jié)雌孕激素方案在凍融胚胎移植中的臨床應用[D];鄭州大學;2013年

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本文編號：1937734