Levitas Eliahu, Lunenfeld Eitan, Har-Vardi Iris, Albotiano Sarit, Sonin Yael, Hackmon-Ram Rinat, Potashnik Gad
Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
Fertil Steril. 2004 Mar;81(3):567-71. doi: 10.1016/j.fertnstert.2003.08.031.
To compare blastocyst-stage embryo transfers (ETs) with day 2-3 ETs in patients who failed to conceive in three or more day 2-3 IVF/ET cycles.
Prospective, randomized.
Fertility unit in a university medical center.
PATIENT(S): Fifty-four patients with an adequate ovarian response underwent oocyte retrievals. The patients were prospectively and randomly divided into blastocyst-stage and day 2-3 ET groups.
INTERVENTION(S): Ovarian down-regulation was obtained using GnRH agonist, and controlled ovarian hyperstimulation was achieved using daily administration of gonadotropins.
MAIN OUTCOME MEASURE(S): The rate of blastocyst formation, ET cancellations, pregnancies, implantation, multiple gestation, and live births.
RESULT(S): The clinical pregnancy rates per oocyte retrieval were 21.7% and 12.9% per blastocyst and day 2-3 ETs, respectively. Although there was a significantly higher implantation rate for blastocyst embryos (21.2%) as compared with 48- to 72-hour embryos (6%), the multiple-pregnancy rate was not significantly different between both groups. An ET cancellation rate of 26% and 6.4% for blastocyst and day 2-3 ETs, respectively, was observed. The presence of two or more 8-cell embryos on day 3 in culture carried a high probability of obtaining blastocysts for transfer.
CONCLUSION(S): This prospective randomized study suggests that in patients with an adequate ovarian response who failed to conceive in at least three IVF/ET cycles [1]. transfer of blastocyst-stage embryos carries a significantly higher implantation rate; [2]. the pregnancy rate per oocyte retrieval and ET are higher in the blastocyst-stage group, even if it did not reach statistical significance; [3]. a higher ET cancellation rate was observed in the whole blastocyst-stage group; [4]. the ET cancellation rate was reduced significantly if the decision to proceed to blastocyst transfer was made on day 3 after oocyte retrieval, which is a post hoc conclusion.
比较在三个或更多个第2 - 3天体外受精/胚胎移植（IVF/ET）周期未受孕的患者中，囊胚期胚胎移植（ET）与第2 - 3天胚胎移植的效果。
前瞻性、随机对照研究。
大学医学中心的生殖科。
54例卵巢反应良好的患者接受了取卵手术。这些患者被前瞻性地随机分为囊胚期移植组和第2 - 3天移植组。
使用促性腺激素释放激素（GnRH）激动剂进行卵巢降调节，并通过每日注射促性腺激素实现控制性卵巢过度刺激。
囊胚形成率、胚胎移植取消率、妊娠率、着床率、多胎妊娠率和活产率。
每次取卵的临床妊娠率在囊胚移植组和第2 - 3天移植组分别为21.7%和12.9%。虽然囊胚胚胎的着床率（21.2%）显著高于48至72小时胚胎（6%），但两组的多胎妊娠率无显著差异。囊胚移植组和第2 - 3天移植组的胚胎移植取消率分别为26%和6.4%。培养第3天出现两个或更多8细胞胚胎时，获得可移植囊胚的可能性很高。
这项前瞻性随机研究表明，对于卵巢反应良好且至少三个IVF/ET周期未受孕的患者，[1]囊胚期胚胎移植的着床率显著更高；[2]囊胚期组每次取卵和胚胎移植后的妊娠率更高，尽管未达到统计学意义；[3]整个囊胚期组观察到更高的胚胎移植取消率；[4]如果在取卵后第3天决定进行囊胚移植，胚胎移植取消率会显著降低，这是一个事后结论。
