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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 explore the possible factors that may lead to the high incidence of monozygotic twins (MZT) in vitro fertilization / IVF / ICSIET and its possible mechanism. METHODS: A total of 2 885 cycles of IVF / ICSI-ET were retrospectively analyzed. Among them, 2 184 cycles of fresh embryo transfer (1 473 cycles of conventional IVF-ET and 711 cycles of ICSI) and cycles of freeze-thaw embryo transfer A, statistics of the incidence of MZT pregnancy cycles, and analyze the factors that may affect its occurrence. Results: The clinical pregnancy rate in 1028 cycles was 1022 cases, the incidence of multiple pregnancy was 20.78% (229/1 102). Among them, 20 cases of MZT (double chorionic twin and single chorionic twin) pregnancy accounted for clinical Pregnancy 1.81% (20/1 102), accounting for 8.73% of multiple births (20/229). MZT single egg double chorionic twins in 5 cases, accounting for 25% (5/20) of MZT, single ovary single chorionic twins in 15 cases, accounting for 75% of MZT (15/20). The incidence of MZT in ICSI was 1.76% (5/284), which was higher than that of routine IVF-ET (1.56%, 9/575), but there was no significant difference (P> 0.05). In the 701 cycles of FET group, there were 243 cycles of clinical pregnancy, 34 cases of multiple births and 6 cases of MZT, accounting for 17.65% (6/34) of the multiple births. In the 2 184 cycles of fresh transplantation, there were 859 cycles of clinical pregnancy and 195 cases of multiple births , MZT 14 cycles, accounting for 7.18% (14/195) with multiple births, there was a significant difference in multi-birth rate between FET group and fresh-cycle transplantation group (P <0.05). In 204 cycles of blastocyst transplantation 95 cases of pregnancy, 12 cases of multiple births, MZT 3 cases, accounting for 25% of multiple births (3/12), non-blastocyst transplantation 2 681 cycles of pregnancy 1 007 cases, 217 cases of multiple births, MZT 17 Cases, accounting for 7.83% (17/217) of multiple births, there was a significant difference in multiple birth rate between blastocysts transplantation group and non-blastocyst transplantation group (P <0.05). The incidence of MZT in frozen-thawed blastocysts was significantly higher than that in non-frozen-thawed blastocysts (P <0.05). There was no significant difference in age, ovulation induction schedule, ovulation induction days, gonadotrophin (Gn) dosage and time, number of high quality embryos and number of embryos transferred between MZT and non-MZT pregnant women in IVF-ET (P> 0.05 ). Conclusion: The incidence of MZT was significantly higher than that of spontaneous pregnancy in IVF / ICSI-ET. Transplantation of frozen-thawed blastocysts was significantly higher than that of frozen-thawed non-blastocyst transplantation, which may be related to the culture conditions in vitro and the application of cryosurgery technology. Increased hardness, resulting in easy to incarcerated blastocyst nesting, resulting in the occurrence of MZT. Simple micro-insemination technology will not significantly increase the incidence of MZT.