Abstract:

Objective　To explore the effect of PDCA cycle management in reducing the twin pregnancy rate in women taking fresh cycle embryo transfer of in vitrofertilization-embryo transfer (IVF-ET) by the early follicular long-term protocol. Methods　The clinical pregnancy outcomes of the women taking fresh cycle embryo transfer of IVF/intracytoplasmic sperm injection (ICSI) by the early follicular long-term protocol for the first time at Department of Reproductive Medicine, First Hospital, Nanjing Medical University in 2018 were retrospectively analyzed. The quality improvement objectives, increasing the selective single embryo transplantation rate and decreasing the twin pregnancy rate, were put forward. The PDCA (plan, do, check, and action) management cycle was employed, and corresponding regulations and standardized procedure were formed; in 2019 in the next cycle, it was applied to reduce the twin pregnancy rate. The data in 2018 and 2019 were matched by the propensity score method to eliminate the interference factors. t test, nonparametric rank sum test, and χ² test or Fisher's precision probability were applied, If P<0.05, there is a statistical difference. Results　A total of 1 429 patients with egg retrieval cycles were included, including 603 patients (603 cycles) in 2018 and 826 patients (826 cycles) in 2019. The rate of single embryo transplantation in 2019 was higher than that in 2018 [59.20%(357/603) vs. 80.75%(667/826)]; the twin pregnancy rate in 2019 was lower than that in 2018 [21.57%(88/408) vs. 8.22%(43/523)]; there were statistical differences (both P<0.001). The implantation rate, clinical pregnancy rate, and live birth rate in 2019 were not significantly lower than those in 2018, and the miscarriage rate was not significantly higher(all P>0.05）. Conclusion　Continuous PDCA cycle management of embryo number during assistant pregnancy can reduce the embryo number and twin pregnancy rate, so it is worth being generalized.

Key words:

In vitrofertilization-embryo transfer, PDCA, Selective single embryo transfer, Twin pregnancy

摘要：

目的　探讨应用PDCA循环管理降低早卵泡期长方案新鲜周期体外受精-胚胎移植（IVF-ET）多胎妊娠率的效果。方法　回顾性分析在2018年南京医科大学第一附属医院生殖医学中心接受首次IVF/卵胞浆内单精子注射技术（ICSI）助孕采用早卵泡期长方案新鲜周期胚胎移植患者的临床妊娠结局，提出质量改进目标—提高选择性单胚胎移植率，降低双胎妊娠率，采用PDCA［P（计划）、D（实施）、C（检查）、A（处理）］管理循环，形成相应的规定和标准化流程，在2019年下一个循环中加以推广应用，降低双胎妊娠率。采用倾向性评分法（PSM）对2018年及2019年两组数据进行匹配，消除干扰因素，采用t检验、非参数秩和检验、χ²检验或Fisher确切概率法，以P<0.05为差异有统计学意义。结果　共纳入1 429个取卵周期患者，其中2018年603例（603个周期），2019年826例（826个周期）。与2018年早卵泡期长方案鲜胚移植患者相比，2019年单胚胎移植占比上升［59.20%（357/603）比80.75%（667/826）］，双胎妊娠率下降［21.57%（88/408）比8.22%（43/523）］，差异均有统计学意义（均P<0.001）；但2018年、2019年两组患者种植率、临床妊娠率、活产率无明显下降，流产率无明显增加（均P>0.05）。结论　在辅助生殖助孕过程中对胚胎移植数量实施持续PDCA循环管理，可达到降低胚胎移植数目及双胎妊娠率，值得推广应用。

关键词:

体外受精-胚胎移植, PDCA, 选择性单胚胎移植, 双胎妊娠