33 KB104 KB29 KB192920262009Gavrić-Lovrec, VidaIvec, MartinKovač, VilmaKovačič, BorutReljič, MilanVlaisavljević, Veljkoštevilka:1letnik:78str. I-63-I-68ISSN:1318-0347COBISSID:3484735URN:URN:NBN:SI:doc-RQP80Y0HslSlovensko zdravniško društvoZdravniški vestnikBlastocistaBlastocystEmbryo TransferfertilizationFertilization in Vitroin vitro fertilizationoploditevOploditev in vitroPregnancy, Multipleumetna oploditevVečplodna nosečnostZarodek, prenoszarodkiKumulativna stopnja zanositve po prenosu enega zarodka| Cumulative pregnancy rate after elective single embryotransfer| prispevek programa vitrifikacije zarodkov| the impact of embryo vitrification programme|Background. Multiple pregnancies are undesired consequence of infertility treatment by in vitro fertilization (IVF). In 2008 the Health Insurance Institute of Slovenia strove for lowering number of multiple pregnancies. It widened the rights of patients by reimbursement of two additional lVF cycles, having totally six cycles reimbursed. But in women younger than 36, only one top-quality embryo in the first two IVF cycles has to be transferred. The aim of the study was to assess, how the new approach, including also the transfers of frozen-thawed embryos, influenced the IVF outcomes. Methods. In year 2008, the transfer of one optimal embryo had to be done in 47.4 % (287/650) of IVF cycles. The criteria for optimality of early cleavage stage embryos were: at least 6 blastomeres and less than 20 % of fragmentation, and for blastocysts: expanded blastocoel and oval inner-cell-mass. Embryos were cultured to blastocysts in 79.4 % (228/287) of cycles. The surplus blastocysts were vitrifted in 172 cydes. The transfer of devitrified blastocysts was performed in 82 patients, which did not conceive in fresh cycle. The pregnancy rate and twins rate after fresh transfers and after transfers of devitrified embryos were analyzed. Results. Single embryo or blastocyst transfer was done in 58.9 % of women. In the remaining 41.1% of cycles the embryos were morphologically not optimal and we decided for double embryo or blastocyst transfer: In the group in which a single and mostly the only embryo was transferred, only 17.2 % of women became pregnant. After the transfer of elective single blastocyst, 51. 4 % of women conceived. After double blastocyst transfer, 40.9 % of patients conceived and 50 % of them had twins. The replacement of devitrified blastocysts was successful in 23.2%. The cumulative pregnancy rate in group of cycles with single fresh blastocyst transfer, followed by transfers of devitrified blastocysts, was 62.9 %. The cumulative pregnancy and multiple pregnancy rate in the whole group was 50.9 % and 14.4 %, respectively. Conclusions. By the policy of reduction the number of transferred embryos into the uterus in IVF programme, the multiple pregnancy rate decreased from previously 40 % down to 14.4 %Izhodišča. Večplodne nosečnosti so neželen pojav, ki spremlja postopek oploditve z biomedicinsko pomočjo (OBMP). Leta 2008 je Zavod za zdravstveno zavarovanje poskušal doseči zmanjšanje deleža večplodnih zanositev. Razširil je pravice zavarovank z dodatnima dvema ciklusoma na vsega skupaj šest ciklusov OBMP, a določil prenos enega zarodka optimalne kakovosti v prvih dveh postopkih OBMP pri ženskah, mlajših od 36 let. Namen raziskave je bil ugotoviti, kako takšen pristop, ki vključuje tudi prenos odmrznjenih zarodkov, vpliva na uspešnost postopkov OBMP. Metode. V letu 2008 bi v 47,4 % (287/605) ciklusov morali opraviti prenos enega optimalnega zarodka. Merilo optimalnosti je bilo za tri dni stare zarodke: vsaj 6 blastomer in manj kot 20% fragmentov; in za blastociste: ekspandirani blastocel in ovalna notranja celična masa. Zarodke smo gojili do blastociste v 79, 4 % (228/287) ciklusov. V 172 ciklusih smo nadštevilne blastociste zamrznili po metodi vitrifikacije. Prenos odmrznjenih blastocist smo naredili pri 82 bolnicah, ki niso zanosile v svežem ciklusu. Analizirali smo delež zanositev po prenosu svežih in prenosu odmrznjenih zarodkov ter delež dvojčkov. Rezultati. En zarodek oziroma blastocisto smo prenesli v 58,9 % ciklusov, medtem ko smo se v preostalih 41,1% primerov, kjer morfološki izgled zarodkov ni bil optimalen, odločili za prenos dveh zarodkov ali blastocist. V skupini, kjer smo prenesli en, večinoma tudi edini zarodek, je zanosilo 17,2 % žensk. Po prenosu ene blastociste je zanosilo 51,4 % žensk. Po prenosu dveh blastocist je bilo 40,9 % žensk nosečih, med njimi 50 % z dvojčki. Uspešnost po prenosu odmrznjenih blastocist je bila 23,2 %. Kumulativna stopnja zanositve v skupini žensk, pri katerih smo prenesli eno svežo blastocisto, in v naslednjih ciklusih opravili prenos še odmrznjenih blastocist, je znašala 62,9 %. Kumulativna stopnja zanositve v celotni skupini je bila 50,9 %, delež večplodnih nosečnosti pa le 14,4 %. Zaključki. Z omejevalno politiko prenosa več zarodkov v maternico v programu OBMP se je delež večplodnih nosečnosti znižal iz nekdanjih 40 % na 14,4 %TEXTznanstveno časopisjejournalsSlovenian National E-content AggregatorNational and University Library of SloveniaSlovensko zdravniško društvo