Niu Zhi-Hong, Feng Yun, Zhang Ai-Jun, Zhang Hui-Qin, Sun Yi-Juan, Lu Xiao-Wei
Reproductive Medical Center, Ruijin Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China.
Zhonghua Fu Chan Ke Za Zhi. 2009 Jun;44(6):413-7.
To analysis high risk factors of twin pregnancy after double-embryo transfer in fresh in vitro fertilization-embryo transfer (IVF-ET) cycles.
From Jan. 2003 to Dec. 2007, 275 infertile cases underwent IVF-ET or intracytoplasmatic sperm injection (ICSI) and obtained clinical pregnancy in Reproductive Medical Center, Ruijin Hospital affiliated to Shanghai Jiaotong University. A total of 280 cycles were performed, which were classified into single pregnancy group (198 cycles) and twin pregnancy group (82 cycles). The general information, patient and embryo characteristics were compared between those two groups, then univariate and multivariate regression were analyzed.
(1) There was no statistical difference in the following clinical features between single and twin pregnancy groups, such as patients ages, the ratio of secondary infertility, period and possible causes of infertility (P > 0.05). (2) When comparing basal level of follicle stimulating hormone (FSH), mean numbers of follicles, mean obtained ovum, ovarian responsibility (ratio of follicle stimulation hormone dose/number of oocyte retrieved), endometrial thickness given by human chorionic gonadotropin (hCG), no significant difference were observed between two groups (P > 0.05). Twin pregnant group had fewer cycles of in vitro fertilization treatment when compared with single pregnancy group (0.18 +/- 0.16 vs. 0.22 +/- 0.21, P = 0.03). (3) No significant difference was observed in the following clinical index, including fertilization approaches, mean numbers of embryo, mean score of transferred embryo, developmental stage of top quality embryo, morphological score of embryo, morphological score of the second best embryo transferred (P > 0.05). The number of top-quality embryos and the development stage score of the second best embryo transferred were higher than those of single pregnant group (3.8 +/- 3.3 vs. 2.9 +/- 2.5, P < 0.05 and 3.7 +/- 0.2 vs. 3.4 +/- 0.2, P < 0.05). (4) Multivariate regression analysis showed that four variables was correlated independently with twin pregnancy including first treatment cycle of IVF-ET (OR = 1.82, P = 0.02), number of good quality embryos (OR = 1.35, P = 0.01), development stage score of the second best embryo (OR = 1.55, P = 0.009) and ovarian responsibility (OR = 0.96, P = 0.04).
It is advisable to perform single embryo transfer. If patients are at high risk factors of twin pregnancy including initial IVF-ET treatment, good ovarian responsibility, more number of top-quality embryos and development stage score of the second best embryo transferred.
分析新鲜体外受精-胚胎移植（IVF-ET）周期双胚胎移植后双胎妊娠的高危因素。
2003年1月至2007年12月，275例不孕症患者在上海交通大学附属瑞金医院生殖医学中心接受IVF-ET或卵胞浆内单精子注射（ICSI）并获得临床妊娠。共进行了280个周期，分为单胎妊娠组（198个周期）和双胎妊娠组（82个周期）。比较两组的一般资料、患者及胚胎特征，然后进行单因素和多因素回归分析。
（1）单胎妊娠组和双胎妊娠组在患者年龄、继发不孕比例、不孕病程及可能病因等临床特征方面无统计学差异（P>0.05）。（2）比较基础卵泡刺激素（FSH）水平、平均卵泡数、平均获卵数、卵巢反应性（促卵泡激素剂量/取卵数之比）、人绒毛膜促性腺激素（hCG）日子宫内膜厚度，两组间无显著差异（P>0.05）。双胎妊娠组的体外受精治疗周期数少于单胎妊娠组（0.18±0.16 vs. 0.22±0.21，P = 0.03）。（3）在受精方式、平均胚胎数、移植胚胎平均评分、优质胚胎发育阶段、胚胎形态评分、移植的次优胚胎形态评分等临床指标上无显著差异（P>0.05）。双胎妊娠组移植的优质胚胎数和次优胚胎发育阶段评分高于单胎妊娠组（3.8±3.3 vs. 2.9±2.5，P<0.05；3.7±0.2 vs. 3.4±0.2，P<0.05）。（4）多因素回归分析显示，与双胎妊娠独立相关的四个变量包括首次IVF-ET治疗周期（OR = 1.82，P = 0.02）、优质胚胎数（OR = 1.35，P = 0.01）、次优胚胎发育阶段评分（OR = 1.55，P = 0.009）和卵巢反应性（OR = 0.96，P = 0.04）。
建议进行单胚胎移植。如果患者存在双胎妊娠的高危因素，包括初次IVF-ET治疗、良好的卵巢反应性、较多的优质胚胎数以及移植的次优胚胎发育阶段评分。
