Elective single embryo transfer (eSET) policy in the first three IVF/ICSI treatment cycles.
Elective single embryo transfer (eSET) policy in the first three IVF/ICSI treatment cycles.
复制标题
前三个 IVF/ICSI 治疗周期中的选择性单胚胎移植 (eSET) 政策。
作者：
A. V. van Montfoort;J. Dumoulin;J. Land;E. Coonen;J. Derhaag;J. Evers
背景
选择性单胚胎移植(ESET)在胚胎质量良好的年轻患者的第一或第二体外受精周期中应用，已被证明在不影响总体妊娠率的情况下降低了双胎妊娠率。目前尚不清楚ESET是所有治疗周期的首选转移策略，还是应该仅限于前两个周期。
方法
在前三个治疗周期中，ESET政策(当有两个或更多胚胎可用，其中至少一个是高质量的)提供给38岁以下的患者。对治疗周期结果进行回顾性研究。
结果
在326例患者中，共进行了586个疗程(326个第一疗程、168个第二个疗程和92个第三个疗程)。在65个周期(11%)中，由于没有受精或只有一个胚胎可用而无法应用ESET。在剩余的521个周期中，111个周期(19%)进行了ESET，而在410个周期中，由于没有高质量的胚胎可用，导致两个胚胎移植(双胚胎移植，DET)。在第一个治疗周期(均为33%)、第二个治疗周期(分别为36%和23%)和第三个治疗周期(分别为20%和24%)中，ESET和DET在移植新鲜胚胎后的持续妊娠率没有显著差异。与DET周期相比，在明显更多的ESET周期中，胚胎能否被冷冻。这导致ESET后的累积妊娠率显著高于DET。
结论
对于年龄小于38岁且至少有一个优质胚胎的患者，ESET至少可以作为前三个治疗周期的首选移植策略，因为每个治疗周期获得的妊娠率与DET后的妊娠率相当。
BACKGROUND
Elective single embryo transfer (eSET), applied in the first or second IVF cycle in young patients with good quality embryos, has been demonstrated to lower the twin pregnancy rate, while the overall pregnancy rate is not compromised. It is as yet unclear whether eSET could be the preferred transfer policy in all treatment cycles, or that it should be restricted to the first or first two cycles.
METHODS
eSET policy (when two or more embryos were available, at least one of them being of good quality) was offered to patients younger than 38 years in the first three treatment cycles. Retrospectively, treatment cycle outcome was studied.
RESULTS
In 326 patients, 586 treatment cycles were performed (326 first, 168 second and 92 third treatment cycles). In 65 cycles (11%), eSET could not be applied because there was either no fertilization, or only one embryo available. In the remaining 521 cycles, eSET was performed in 111 cycles (19%), while in 410 cycles, no good quality embryo was available resulting in the transfer of two embryos (double embryo transfer, DET). No significant differences in ongoing pregnancy rates after transfer of fresh embryos were observed between eSET and DET in the first (both 33%), second (36 and 23%, respectively) and third treatment cycles (20 and 24%, respectively). In significantly more eSET cycles compared to DET cycles, could embryos be frozen. This resulted in a significantly higher cumulative pregnancy rate after eSET compared to DET.
CONCLUSIONS
In patients younger than 38 years with at least one top quality embryo, eSET can be the transfer policy of choice in at least the first three treatment cycles, since the pregnancy rates obtained in each treatment cycle are comparable to those after DET.