| ART (assisted reproductive technology) is the most effective way to treat the infertility, IVF-ET (in vitro fertilization-embryo transfer) is the most representative one. Pregnancy complications after IVF has related growing concern by the people. One of the most serious complications is EP (ectopic pregnancy). At the same time, cervical pregnancy, ectopic pregnancy combined with intrauterine pregnancy and some other rare diseases increased in the incidence of assisted reproduction. Domestic and foreign scholars generally believe that possible reasons for occurrence of EP after ART are those ones, such as, rubal disease, endometriosis, transfer tube insertion depth of the uterine cavity, the amount of fluid in transfer tube, the rate of transplantation, the number of implanted embryos, position of patients, embryo migration in Intrauterine, development synchronization among embryo and endometrial, and other factors. The most high risk factor which cause EP after ART is tubal disease.In clinical work, more time for the embryo are cleavage stage and blastocyst stage, cleavage stage embryo transfer is divided into the next day and the third day. At present, doctors in China more transplant on the next day or the third day after fertilization. With the development of in vitro culture in recent years, more and more reproductive center transplant the fifth-day or the sixth-day blastocyst. There is no consistent conclusion whether transplantation at different times affect the incidence of ectopic pregnancy after IVF or not.ObjectivesWe will discuss the following questions by comparing the clinical data of those patients who transplanted on day 2 or day 3 in IVF-ET, ICSI (intracytoplasmic sperm injection) and F-ET (frozen-thawed embryo transfer) cycles:(1) Whether clinicians select the specific time of transplant is associated with the patients by their own characteristics, who accept day 2 or day 3 transplant in vitro fertilization.(2) Whether there are differences in pregnancy outcomes between day 2 or day 3 transplant patients, whether there are differences between ectopic pregnancy rate among progesterone by different way, and it can provide the basis data for clinical works.(3) Within three groups IVF-ET, ICSI and F-ET, compare tubal factor infertility patients undergoing assisted reproductive technology treatment of the proportion of the whole, clear whether the ectopic pregnancy rate between the proportion of D2 and D3 specific transplantation with tubal infertility interference or not.(4) Compare the ectopic pregnancy rate among IVF-ETn ICS,F-ET patients who transplanted on day 2 or day 3 with same premise of tubal factor, if reveal the effect of excluding tubal, whether day 2 or day 3 transplantation impact the ectopic pregnancy rate.(5) Comparison of IVF-ET, ICSI, F-ET occurred in the progesterone group of patients with ectopic pregnancy, their share of the ratio with or without tubal disease, reveale the connection degree between tubal disease and ectopic pregnancy.MethodsRetrospective study of clinical data of 754 patients undergoing IVF-ET treatment,599 patients undergoing ICSI treatment,773 patients undergoing F-ET treatment, who had accepted cleavage stage embryo transfer, from the Reproductive Center of The First Affiliated Hospital of Zhengzhou University from March 2009 to December 2009. Inclusion criteria:1).Autologous sperm are used.2).GnRHa down-regulation long protocol are used in the previous mid-luteal. The group is divided into day 2 or day 3 transplantation By embryo transfer time. The group is divided into with and without tubal factor infertility by tubal factor infertility.Fresh cycle of IVF was according to routine operation,48-72 hours after oocyte retrieval was according to Peter grading criteria to select good quality embryos for transplantation. Frozen embryo transfer cycle time was based on day of ovulation and the number of frozen embryos to derive cells on day 2 or 3 days transplantation. Number of transferred embryos in patients was no more than two when age<35 years old and first transplant,≥35 years of age or≥2 or F-ET cycles transplantation three. Tube graft transplanted from the Palace of the end of the depth was 1.5cm.35 days after transplantation, B-mode ultrasound, pregnant capsule for clinical pregnancy, including ectopic pregnancy.Select the patient's age, duration of infertility, assisted reproductive cycles, primary/secondary, number of Gn aggregate expenditure, Gn total number of days, number of oocytes retrieved, number of transferred embryos, clinical pregnancy rate, miscarriage rate, ectopic pregnancy, multiple pregnancy rate and other clinical data, and between groups were compared within groups, and statistical analysis.Results1. In IVF-ET and ICSI progesterone group, average age of patients who transplanted on day 2 was significantly higher than those transplanted on day 3, there are significant differences (P<0.05). The average age of patients who transplanted on day 2 or day 3 was not significant difference both in Natural cycle and Artificial cycle undergoing F-ET (P>0.05).2. The IVF-ET, ICSI, respectively, two groups of patients were divided into age <35 years group and the≥35 age group, grouped day 2 or day 3 transplant patients age, duration of infertility was no significant difference (P>0.05);(1) IVF-ET<35 age group:The transplant IVF assisted reproductive cycles, the proportion of primary infertility, and the number of Gn aggregate expenditure on day 2 embryo transfer was significantly higher than day 3 transplantation (P<0.05), day 3 transplantation retrieved oocytes, number of transferred embryos and secondary infertility was significantly higher than that of day 2 transplantation (P<0.05); the clinical pregnancy rate of day 3 transplant was significantly higher than day 2 transplantation (P<0.05), the ectopic pregnancy rate, miscarriage rate, multiple pregnancy rate was no significant differences in day 2 and day 3 transplantation group (P>0.05);(2) IVF-ET> 35 age group:day 3 transplantation retrieved oocytes, number of transferred embryos was significantly higher than day 2 transplantation (P<0.05), there was no significant difference in the proportion of primary infertility/secondary infertility and IVF assisted reproductive cycles in day 2 and day 3 transplantation group (P>0.05); multiple births of day 3 transplantation was higher than day 2 transplantation (P<0.05), the clinical pregnancy, ectopic pregnancy and abortion rates was not statistically different on day 2 and day 3 transplantation (P>0.05);(3) ICSI<35 age group:day 2 portable ICSI assisted reproductive cycles, number of Gn aggregate expenditure was significantly higher than day 3 transplantation (P<0.05), day 3 transplantation retrieved oocytes, number of transferred embryos was significantly higher than day 2 transplantation(P＜0.05); the clinical pregnancy rate with day 3 transplantation was significantly higher than day 2 transplantation (P<0.05), the ectopic pregnancy rate, miscarriage rate and multiple pregnancy rate was no statistical difference among day 2 and day 3 transplantation(P>0.05);(4) ICSI> 35 age group:day 2 transplantation was significantly higher than the number of Gn aggregate expenditure on day 3 transplantation (P<0.05), day 3 transplantation retrieved oocytes, number of transferred embryos was significantly higher than day 2 transplantation (P<0.05), the assisted reproductive in ICSI cycles was not significant difference on day 2 and day 3 transplant(P>0.05); the clinical pregnancy, ectopic pregnancy, miscarriage rate, multiple pregnancy rate on day 2 and day 3 transplant was not statistical difference (P>0.05);(5) F-ET natural cycle:day 2 and day 3 transplant patients transplanted F-ET assisted reproductive cycles, primary infertility/proportion of secondary infertility, age, duration of infertility were not significantly different (P>0.05); the number of transferred embryos on day 3 transplantation was significantly higher than day 2 transplantation (P<0.05); day 3 transplant clinical pregnancy rate was significantly higher than day 2 transplantation (P＜0.05), the ectopic pregnancy rate, miscarriage rate, multiple pregnancy rate among day 2 and day 3 transplantation were no statistically significant difference (P>0.05);(6) F-ET artificial cycle:day 2 and day 3 transplant patients transplanted F-ET assisted reproductive cycles, primary infertility/proportion of secondary infertility, age, duration of infertility were not significantly different(P>0.05); day 3 embryo transplantation was significantly higher than day 2 transplantation (P<0.05); the clinical pregnancy, ectopic pregnancy, miscarriage rate, multiple pregnancy rate were not statistical difference between day 2 and day 3 transplant(P> 0.05).3. IVF-ET, ICSI, F-ET in the three groups day 2 and day 3 transplantation transplanted tubal infertility ratio and the proportion of non-tubal infertility were not significantly different (P> 0.05).4. In each group of IVF-ET, ICSI, F-ET, the same age groups face the same tubal factor cases, the ectopic pregnancy rate was not statistically significant among day 2 and day 3 transplantation (P> 0.05).5. Ectopic pregnancy in IVF-ET patients with tubal disease was significantly higher than the proportion of patients without tubal disease proportion (P<0.05); there were no statistically significant in the proportion of patients who had ectopic pregnancy undergoing ICSI with and without tubal disease(P>0.05); F-ET in the natural cycle of the proportion of patients with tubal disease was significantly higher than the proportion of patients with tubal disease (P<0.05); F-ET artificial cycles with tubal disease proportion of patients comparison the proportion of patients without tubal disease, no statistical Studies significant (P>0.05).6. The ectopic pregnancy rate among the three IVF-ET, ICSI, F-ET groups showed a decreasing trend, but no significant difference(P>0.05).Conclusion1. In IVF cleavage stage transfer, the ectopic pregnancy rate on day 2 and day 3 transplantation was not statistically significant difference. So, when we need to judge day 2 or day 3 to embryo transfer, selection of specific transplant time according to the actual situation of patients may more reasonable than choosing all patients fixed in one day transplantation.2. IVF cleavage stage transfer, day 3 than the day 2 graft transplantation was significantly higher clinical pregnancy rate. If the patient can choose the case of day 3 transplantation(Cleavage stage embryos), the clinical pregnancy rate will be higher.3. The major risk factor which cause ectopicpregnancy after assisted reproductive technology treatment is tubal factor infertility, we should strengthen the monitoring of high-risk patients. |
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