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目的:分析行IVF/ICSI的各年龄段妊娠妇女早期单、双胎妊娠胚胎丢失的影响因素。方法:回顾性分析行IVF/ICSI治疗,授精后第2日或第3日移植2~3个胚胎后单、双胎妊娠周期中早期妊娠囊丢失情况。结果:共收集到1 674个IVF/ICSI周期,孕6周单胚胎着床1 077例,双胚胎着床597例。孕12周时单胎和双胎的继续妊娠数分别为901例(83.66%)和548例(91.79%)(P<0.001)。双胎妊娠中,21例(3.52%)自然减胎成单胎,28例(4.69%)自然流产。单胎和双胎妊娠中,每个着床妊娠囊的丢失率分别为16.34%(176/1 077),6.45%(741/1 194)(P<0.001)。妊娠妇女早期妊娠囊丢失率单胎者高于同年龄段双胎妊娠者,26~37岁各年龄段妇女单胎与双胎妊娠丢失率间差异均有统计学意义(P<0.05),≥38岁妇女双胎妊娠丢失率显著增加。单胎妊娠组Gn每日用量显著高于双胎妊娠组(P<0.05),而受精率及优质胚胎率单胎妊娠组显著低于双胎妊娠组(P<0.001),Gn每日用量、受精率及优质胚胎率在妊娠丢失组和继续妊娠组间无统计学差异(P>0.05)。结论:双胎妊娠早期能获得更好的继续妊娠机会,随年龄增加尤其是≥38岁妇女,妊娠丢失显著上升。胚胎形态学质量好则有助于双胚胎着床,但是对继续妊娠没有直接明显的影响。
OBJECTIVE: To analyze the influencing factors of embryo loss in early single and twin pregnancies of IVF / ICSI women of all ages. Methods: We retrospectively analyzed the loss of early gestational sac in IVF / ICSI and single or twin pregnancy after 2 or 3 embryo transfer on the second or third day after fertilization. RESULTS: A total of 1 674 cycles of IVF / ICSI were collected, with 1 077 single embryo implantation and 597 double embryo implantation at 6 weeks of gestation. Twelve weeks of pregnancy, the number of single and twin pregnancies continued to be 901 (83.66%) and 548 (91.79%), respectively (P <0.001). Twins pregnancy, 21 cases (3.52%) natural abortion reduced to singleton, 28 cases (4.69%) of spontaneous abortion. In single and twin pregnancies, the rates of loss of each gestational sac for implantation were 16.34% (176/1 077) and 6.45% (741/1 194), respectively (P <0.001). The rate of early pregnancy loss in pregnant women was higher than that of single pregnancy in the same age group. There was significant difference in the loss of singleton and twin pregnancy among women aged 26-37 (P <0.05), ≥ 38-year-old women lost a significant increase in twin pregnancy. The single dose of Gn in singleton pregnancy group was significantly higher than that of twin pregnancy group (P <0.05), while the fertilization rate and high quality embryo rate of singleton pregnancy group were significantly lower than that of twin pregnancy group (P <0.001) There was no significant difference in fertilization rate and quality embryo rate between the lost pregnancy group and the continuous pregnancy group (P> 0.05). CONCLUSIONS: Better twins have a better chance of continuing pregnancy in early stages of twin pregnancy. Pregnancy loss increases significantly with age, especially in women over 38 years of age. Good morphological morphology of embryos help double embryo implantation, but there is no direct and obvious effect on the continuation of pregnancy.