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目的:探讨在既往胚胎种植失败患者的解冻周期中如何合理化应用辅助孵化(AH)。方法:本研究共纳入了579名既往种植失败的患者,其中242例行激光AH(LAH组),337例未行AH(对照组)。比较组间临床妊娠率、种植率及活产率等;另根据患者的年龄、既往移植次数、胚胎评分及移植胚胎受精方式再进行分组,比较不同组别的妊娠结局。结果:妊娠率、种植率及活产率在LAH组与对照组组间无统计学差异(P>0.05),但分组分析结果显示,既往移植次数>2次的患者以及移植卵泡质内单精子显微注射(ICSI)胚胎的患者,LAH能显著提高活产率(25.5%vs 5.3%;37.0%vs 23.9%,P<0.05)。结论:LAH并不适合作为解冻胚胎移植的常规移植策略,但对于既往移植次数>2次的未孕者及移植ICSI胚胎的患者,LAH能明显改善妊娠结局。
OBJECTIVE: To explore how to rationalize the use of assisted hatching (AH) in thawing cycles in patients with failed prior embryo implantation. METHODS: A total of 579 patients with previously impaired plantation were included in this study, 242 of whom underwent laser AH (LAH) and 337 did not receive AH (control). The clinical pregnancy rate, implantation rate and live birth rate among the groups were compared. According to the patient’s age, the number of previous transplants, the embryo score and the transplanted embryo fertilization, the pregnancy outcomes of different groups were compared. Results: The pregnancy rate, implantation rate and live birth rate were not significantly different between LAH group and control group (P> 0.05). However, the group analysis showed that the patients with previous transplantation> 2 times as well as the single intraperitoneal injection of follicles In patients with microinjection (ICSI) embryos, LAH significantly increased live births (25.5% vs 5.3%; 37.0% vs 23.9%, P <0.05). CONCLUSIONS: LAH is not suitable as a routine transplantation strategy for thawed embryos, but LAH can significantly improve pregnancy outcome in non-pregnant women who have previously been transplanted> 2 times and in ICSI embryos.