Coulam C B, Chapman C, Rinehart J S
Center of Human Reproduction, Chicago, Illinois 60610, USA.
J Assist Reprod Genet. 1998 Apr;15(4):184-7. doi: 10.1023/a:1023044217810.
To evaluate the contribution of embryo quality to preclinical loss rates after in vitro fertilization (IVF)/embryo transfer (ET) pregnancy, multiple gestation, and clinical loss rates were compared to preclinical pregnancy loss rates over a 3-year period.
The pregnancy outcomes after 1675 fresh ETs from 1994 to 1997 were studied. While establishment of a clinical pregnancy confirms uterine receptivity, multiple gestation rates reflect embryo quality. Because the majority of clinical losses are chromosomally abnormal, clinical loss rates serve as another indicator of embryo quality.
The overall preclinical pregnancy loss rate was 5% (78/1675) of ETs and 17% (78/472) of pregnancies. During the 3-year period the pregnancy rates per ET increased from 19 to 36% (P < 0.0001), multiple gestation rates increased from 21 to 48% (P < 0.008), clinical loss rates decreased from 20 to 6% (P < 0.0001), and preclinical pregnancy loss rates remained unchanged from 13 to 19% (P = 0.1).
Preclinical pregnancy loss more likely reflects abnormalities in uterine receptivity rather than embryo quality. If recurrent preclinical pregnancy loss occurs after IVF/ET, evaluation for abnormalities of uterine receptivity should be performed.
评估胚胎质量对体外受精（IVF）/胚胎移植（ET）后临床前流产率的影响，比较3年期间的多胎妊娠率和临床流产率与临床前妊娠流产率。
研究了1994年至1997年1675例新鲜胚胎移植后的妊娠结局。临床妊娠的建立证实子宫具有接受性，多胎妊娠率反映胚胎质量。由于大多数临床流产是染色体异常所致，临床流产率可作为胚胎质量的另一个指标。
胚胎移植的总体临床前妊娠流产率为5%（78/1675），妊娠的临床前妊娠流产率为17%（78/472）。在3年期间，每次胚胎移植的妊娠率从19%增至36%（P<0.0001），多胎妊娠率从21%增至48%（P<0.008），临床流产率从20%降至6%（P<0.0001），而临床前妊娠流产率从13%至19%保持不变（P=0.1）。
临床前妊娠流产更可能反映子宫接受性异常而非胚胎质量。如果IVF/ET后发生复发性临床前妊娠流产，应进行子宫接受性异常的评估。
