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中华妇幼临床医学杂志(电子版)

中华妇幼临床医学杂志(电子版) ›› 2013, Vol. 09 ›› Issue (06) : 782 -786. doi: 10.3877/cma.j.issn.1673-5250.2013.06.015

所属专题： 文献；

论著

辅助生殖后单卵双胎的妊娠结局分析
程丹1,*,*(), 杨菁1, 徐望明1, 徐梅1, 邹宇洁1   
  1. 1. 430060　武汉，武汉大学人民医院生殖医学中心
  • 收稿日期:2013-05-10 修回日期:2013-11-04 出版日期:2013-12-01
  • 通信作者: 程丹

Pregnancy Outcomes analysis of Monozygotic Twinnings After Assisted Reproductive Techniques

Dan CHENG1(), Jing YANG1, Wang-ming XU1, Mei XU1, Yu-jie ZOU1   

  1. 1. Reproductive Medical Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China
  • Received:2013-05-10 Revised:2013-11-04 Published:2013-12-01
  • Corresponding author: Dan CHENG
  • About author:
    (Corresponding author : CHENG Dan, Email : )
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程丹, 杨菁, 徐望明, 徐梅, 邹宇洁. 辅助生殖后单卵双胎的妊娠结局分析[J]. 中华妇幼临床医学杂志(电子版), 2013, 09(06): 782-786.

Dan CHENG, Jing YANG, Wang-ming XU, Mei XU, Yu-jie ZOU. Pregnancy Outcomes analysis of Monozygotic Twinnings After Assisted Reproductive Techniques[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2013, 09(06): 782-786.

目的

探讨辅助生殖后单卵双胎(MT)发生率和妊娠结局。

方法

回顾性分析2010年1月至2012年6月在武汉大学人民医院生殖医学中心行辅助生殖获得临床妊娠的患者资料，对比分析MT患者与同期未发生MT患者的辅助生殖临床资料，早、中孕期的流产率与活胎分娩率（本研究遵循的程序符合武汉大学人民医院伦理委员会制定的伦理学标准，得到该委员会批准）。

结果

获得临床妊娠的1710个周期中，MT为16例，发生率为0.94%。其中获得妊娠方式为体外受精-胚胎移植(IVF-ET)者为4例(0. 63%),单精子卵胞浆内显微注射-胚胎移植(ICSI-ET)为4例(1.00%)，冻融胚胎移植(FET)为8例(1.18%)。MT多胎妊娠发生率[MT合并单卵单胎(MP)的三胎妊娠]为6例(37. 50%)，流产为3例(18.8%)。MT患者较非MT患者的流产率高，活胎分娩率低。鲜胚移植中受精方式分别为IVF-ET和ICSI-ET的MT患者与非MT患者比较，MT患者的年龄较低(P<0. 05)，但不孕年限、促性腺激素(Gn)使用时间、Gn使用剂量、获卵数、受精数、卵裂数、可用胚胎数等比较，差异均无统计学意义(P>0. 05)，MT患者的平均移植胚胎数较非MT者高，但二者比较，差异亦无统计学意义(P>0. 05)。行FET的MT患者与非MT患者的子宫内膜准备方式方面，移植日子宫内膜厚度和平均移植胚胎个数比较，差异均无统计学意义(P>0.05)。

结论

辅助生殖的MT在冻胚移植中发生率高，发生MT病例流产率高，妊娠结局不良，在辅助生殖中如何降低MT的发生仍需要进一步研究。

关键词: 双生，单卵, 生殖技术，辅助, 妊娠结局
Objective

To explore incidence rate of monozygotic twinnings (MT) and pregnancy outcomes in patients undergoing assisted reproductive technique.

Methods

Pregnant cases undergoing assisted reproductive technique [in vitro fertilization and embryo transfer (IVF-ET) , Introcytoplasmic sperm injection and embryo transfer (ICSI-ET) and frozen-refreshed embryo transfer (FET)] from January 2010 to June 2012 were collected in Reproductive Medical Center of Renmin Hospital, Wuhan University. Abortion rates and live birth rates were compared between MT and non-MT patients. The study protocol was approved by the Ethical Review Board of Investigation in Renmin Hospital of Wuhan University. Informed consent was obtained from all participates.

Results

1710 cycles with clinical pregnancy were collected. There were 16 MTs (0. 94%),among which 4 cases(0. 63%) occurred in IVF-ET, 4(1. 00%) occurred in ICSI-ET,8(1. 18%) occurred in FET. In MT twins,6 individuals (37. 5%) were accompanied by multi-pregnancy, 3(18.8%) accompanied by abortion. No statistical significances were observed in duration of infertility, period of gonadotropin (Gn) treatment, Gn dosage, number of oocytes,zygotes, blastocysts and accessible embryos between MT patients and non-MT patients. Numbers of embryos transferred were higher in MT patients,but failed to reach a statistical difference. No differences were observed in endometrial thickness and number of embryos transferred between MT patients and non-MT patients in FET treatment. Abortion rate was higher and live birth rate was lower than those in non-MT patients.

Conclusions

MT twins were seen more often in cases with frozen embryo transferred, accompanied by a higher abortion rate and poorer pregnancy outcomes. It required further investigation about how to reduce the incidence of MT using assisted reproductive technique.

Key words: twins, monozygotic, reproductive techniques, assisted, pregnancy outcome
表1 获得妊娠方式与MT发生率、MT多胎发生率的关系[n(%)]
Table 1 The incidences of monozygote twinning and multiple pregnancy in groups with different pattern of achieving pregnancy [n(%)]
获得妊娠方式 移植周期数 (n) 妊娠率 MT发生率 MT多胎妊娠率
IVF-ET 1399 633(45.20) 4(0.63) 2(50.00)
ICSI-ET 932 400(42. 90) 4(1. 00) 1(25.00)
FET 1749 677(38.70) 8(1.18) 3(37.50)
合计 4080 1710(41. 90) 16(0.94) 6(37.50)
表2 鲜胚妊娠MT与非MT临床与实验室资料的比较(±s)
Table 2 Comparision of clinical and laboratory characteristics between MT and non-MT patients after fresh embryo transfer (± s)
项目 n 年龄（岁） 不育年限（年） ?Gn?使用时间 (d) ?Gn?用量（支） 获卵数（个） 受精数（个） 卵裂数（个） 可用胚胎数（个） 移植胚胎数（个）
IVF-ET ? ? ? ? ? ? ? ? ? ?
? MT 4 28. 8±3. 8 5. 2±3. 5 10. 5±2. 2 30. 7±12. 1 11. 9±6. 6 9. 3 ± 4. 4 8. 2±4. 3 7. 1±3. 2 2. 3 ± 0. 6
? 非MT 629 31. 7±4. 9 5. 0±3. 9 11. 4±2. 4 33. 1 ± 12. 8 12. 2±6. 4 10. 1±4. 9 8. 5±4. 3 7. 5±3. 7 2. 1±0. 7
? t ? 3. 62 0. 77 1. 79 1. 53 0. 38 1. 27 0. 22 0. 75 1. 34
? P ? <0.05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05
ICSI-ET ? ? ? ? ? ? ? ? ? ?
? MT 4 29. 1±4. 3 4. 7±3. 3 11. 4±2. 3 32. 5 ± 11. 9 12. 9±6. 1 10. 2 ± 4. 9 9. 7±4. 1 7. 3 ± 3. 4 2. 3 ± 0. 5
? 非MT 396 30. 8±4. 1 4. 9±3. 5 11. 2±2. 4 33. 3±12. 1 11. 9±6. 3 9. 2±4. 6 8. 1±4. 0 7. 2±3. 6 2. 2 ± 0. 8
? t ? 2. 33 0. 17 0. 53 0. 47 0. 66 1. 72 1. 33 0. 22 0. 76
? P ? <0.05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05
合计 ? ? ? ? ? ? ? ? ? ?
? MT 8 29. 6±4. 1 4. 9±3. 5 11. 2±2. 3 31. 5±12. 0 12. 1±6. 5 9. 4 ± 4. 9 8. 5±4. 2 7. 2±3. 4 2. 3±0. 6
? 非MT 1025 31. 2±4. 4 5. 1±3. 7 11. 3±2. 4 32. 7±12. 8 11. 9±6. 3 9. 1±4. 7 8. 4±4. 1 7. 3±3. 4 2. 2±0. 7
? t ? 3. 87 0. 11 0. 45 1. 76 0. 28 0. 64 0. 21 0. 19 1. 37
? P ? <0.05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05 >0. 05
表3 冻胚移植妊娠MT组与非MT组资料的比较（±s）
Table 3 Comparision of datas between MT and Non-MT patiens after frozen-refresh embryo transfer (±s)
项目 例数（个） 年龄（岁） 准备子宫内膜的方式[n(%)] 移植日子宫内膜厚度(cm) 移植胚胎数（个）
人工周期 自然周期
MT 8 30. 1±4. 3 5(62. 5) 3(37. 5) 1. 0±3. 5 2. 6±0. 7
非MT 669 32. 1±4. 1 447(66.8) 222(33.2) 1. 1±3. 1 2. 3±0. 6
合计 677 32. 0±4. 2 452(66.7) 225(33.3) 1. 1±3. 3 2. 3±0. 7
χ2/t ? 3. 11 0. 07 0. 07 2. 24 3. 11
P ? ≤0. 05 >0. 05 >0. 05 ≤0. 05 ≤0. 05
表4 随访结果[n(%)]
Table 4 Results of follow-up[n(%)]
项目 妊娠率 流产率 活胎分娩率
非MT ? ? ?
? 单胎 1175 (69.4) 69(5.9) 1106(94. 1)
? 双胎 398 (23.5) 36(8. 5) 362(91. 5)
? 三胎（减胎） 121 (7. 1) 11(9.1) 110(90. 9)
? 合计 1694(100. 0) 116(6.9) 1578(93. 1)
MT ? ? ?
? 双胎 10 (62.5) 2(20.0) 8(80.0)
? 三胎（减胎） 6 (37. 5) 1(16.7) 5(83.3)
? 合计 16(100. 0) 3(18. 8) 13(81.2)
1
Sills ES, Moomjy M, Zaninovic N, et al. Human zona pellucida micromanipulation and monozygotic twinning frequency after IVF [J]. Hum Reprod, 2000,15(4) : 890-895.
2
Alikani M, Cekleniak NA, Walters E, et al. Monozygotic twinning following assisted conception: An analysis of 81 consecutive cases[J]. Hum Reprod, 2003,18(9) : 1937-1943.
3
Schachter M, Raziel A, Friedler S,et al. Monozygotic twinning after assisted reproductive techniques: A phenomenon independent of micromanipulation[J]. Hum Reprod, 2001,16(6) : 1264-1269.
4
Hagemann AR, Lanzendorf SE, Jungheim ES, et al. A prospective,randomized, double-blinded study of assisted hatching in women younger than 38 years undergoing in vitro fertilization [J]. Fertil Steril, 2010,93(2) : 586-591.
5
Sparks AE. Culture systems: Embryo culture and monozygotic twinning[J]. Methods Mol Biol, 2012,912: 387-397.
6
Blickstein I, Jones C, Keith LG. Zygotic-splitting rates after single-embryo transfers in in vitro fertilization[J]. N Engl J Med, 2003,348(23) : 2366-2367.
7
Milki AA, Jun SH, Hinckley MD, et al. Incidence of monozygotic twinning with blastocyst transfer compared to cleavage-stage transfer[J]. Fertil Steril, 2003,79(3) : 503-506.
8
Moayeri SE, Behr B, Lathi RB, et al. Risk of monozygotic twinning with blastocyst transfer decreases over time : An 8-year experience[J]. Fertil Steril, 2007,87(5) : 1028-1032.
9
Elizur SE, Levron J, Shrim A, et al. Monozygotic twinning is not associated with zona pellucida micromanipulation procedures but increases with high-order multiple pregnancies[J]. Fertil Steril, 2004, 82(2) : 500-501.
10
Skiadas CC, Missmer SA, Benson CB, et al. Risk factors associated with pregnancies containing a monochorionic pair following assisted reproductive technologies [J]. Hum Reprod, 2008,23(6) : 1366-1371.
11
Allegra A, Monni G, Zoppi MA, et al. Conjoined twins in a trichorionic quadruplet pregnancy after intracytoplasmic sperm injection and quarter laser-assisted zona thinning[J]. Fertil Steril, 2007, 87(1): 189.e9-12.
12
Blickstein I, Keith LG. On the possible cause of monozygotic twinning: Lessons from the 9-banded armadillo and from assisted reproduction[J]. Twin Res Hum Genet, 2007,10(2) : 394-399.
13
Rao A, Sairam S, Shehata H. Obstetric complications of twin pregnancies[J]. Best Pract Res Clin Obstet Gynaecol,2004,18 (4): 557-576.
14
Tal R, Fridman D, Grazi RV. Monozygotic triplets and dizygotic twins following transfer of three poor-quality cleavage stage embryos[J]. Case Rep Obstet Gynecol, 2012,2012: 763057.
15
Vela G, Luna M, Barritt J, et al. Monozygotic pregnancies conceived by in vitro fertilization: Understanding their prognosis [J]. Fertil Steril, 2011,95(2) : 606-610.
16
Haimov-Kochman R, Daum H, Lossos F,et al. Monozygotic multiple gestation after intracytoplasmic sperm injection and preimplantation genetic diagnosis[J]. Fertil Steril, 2009,92(6): 2037. e11-7.
17
Skiadas CC, Missmer SA, Benson CB, et al. Impact of selective reduction of the monochorionic pair in in vitro fertilization triplet pregnancies on gestational length[J]. Fertil Steril, 2010,94(7): 2930-2931.
18
Kawachiya S, Bodri D, Shimada N, et al. Blastocyst culture is associated with an elevated incidence of monozygotic twinning after single embryo transfer[J]. Fertil Steril, 2011,95(6) : 2140-2142.
19
Sparks AE. Culture systems: Embryo culture and monozygotic twinning[J]. Methods Mol Biol, 2012,912: 387-397.
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