Down's syndrome in South Australia.

In a survey of Down's syndrome in South Australia, 921 persons, both living and deceased, were identified; 717 individuals with the disorder were living in South Australia. Cytogenetic confirmation of the diagnosis had been made in 774 cases. From 1955 to 1977, the over-all incidence of Down's syndrome at birth was found to be 1.175/1000 live births. The incidence of Down's syndrome was significantly lower over the last five years of this period than for the first 18 years; thus it appears that the incidence of Down's syndrome in South Australia is falling. Analysis of maternal age changes with time has not revealed any changes to the maternal age-specific rates for Down's syndrome, although the rate for mothers aged 25 years or younger appears to be falling. The proportion of Down's syndrome babies born to women aged 35 years or more has decreased from 65.7% for those born before 1950 to 30.4% for those born from 1975 to 1977; similarly, the median maternal age has fallen from 37.12 years to 28.25 years. Regression analyses of maternal age rates for Down's syndrome by single years have produced figures suitable for genetic counselling. A plea is made that Down's syndrome should become a notifiable condition.     

The prevention of Down's syndrome in the south western region of England 1975-1985

Cytogenetic prenatal screening for Down's syndrome in the South West Region of England from 1975 to 1985 was reviewed. The use of amniocentesis increased, and for the years 1981 to 1985 averaged 29.4% of women 35 years or over at their estimated date of delivery. 58 pregnancies were terminated after karyotyping of amniotic fluid cells confirmed trisomy 21. 385,440 live births were born in the region, 452 with Down's syndrome, giving a live birth incidence of 1 in 853. The effective impact of prenatal screening was calculated at an overall 8.3% reduction in Down's syndrome live births, but for the years 1981 to 1985 this rose to 11.3%. In spite of the introduction of new prenatal screening programmes that are not reliant solely on maternal age, it is predicted that substantial numbers of children with Down's syndrome are likely to be born each year. Adequate medical facilities will still be required for the survivors.     

Chromosomal abnormality rates at amniocentesis and in live-born infants

Regression-smoothed maternal age-specific rates of six different categories of cytogenetic abnormalities in recent large-scale prenatal cytogenetic studies were multiplied by independently derived fetal selection coefficients--factors that adjust for the excess likelihood of spontaneous loss of cytogenetically abnormal fetuses--to obtain estimated maternal age-specific rates of these categories of cytogenetic abnormalities in live-born infants. The derived rates apply to women whose only risk factor is advanced maternal age. The categories analyzed were 47,+21 (Down's syndrome), 47,+18 (Edwards' syndrome), 47,+13 (Patau's syndrome), 47,XXY (Klinefelter's syndrome), 47,XXX, and the group of other clinically significant abnormalities considered collectively. The rate of all clinically significant abnormalities considered together derived in this study was about five per 1,000 at age 35 years, 15 per 1,000 at age 40 years, and 50 per 1,000 at age 45 years.     

融胚胎移植与新鲜胚胎移植多胎妊娠率的比较及相关因素分析

目的 比较冻融胚胎移植(FET)与新鲜胚胎移植的多胎妊娠率,分析多胎妊娠的相关因素,探讨移植不同数目的 胚胎对冻胚移植周期临床妊娠率的影响.方法 对经FET获得的1235例临床妊娠与经新鲜胚胎移植获得的1561例临床妊娠中的多胎妊娠进行回顾性分析.结果 多胎妊娠与移植周期(FET或新鲜胚胎移植)无关,而与女方的年龄、移植胚胎数、以及卵裂期胚胎或囊胚移植密切相关.在相同年龄段移植相同数目卵裂期胚胎时,FET 与新鲜胚胎移植的多胎妊娠率差异无统计学意义,增加移植胚胎数主要是增加了三胎妊娠率.＜35岁的妇女移植2个冻融胚胎的临床妊娠率可达36.1%.结论 多胎妊娠率与冻胚移植或新鲜胚胎移植无关.＜35岁的妇女移植2个冻融胚胎可以取得较好的妊娠率,同时可以降低FET周期的三胎妊娠率.     

妊娠中期孕妇血清三联生化标记物在出生缺陷筛查中的应用价值

目的：探讨妊娠中期孕妇血清三联生化标记物在出生缺陷筛查中的应用价值。方法选择我院2014年12月至2015年12月收治的妊娠中期(15~20+6周)孕妇5922例,对所有孕妇进行甲胎蛋白(AFP)、游离人绒毛膜促性腺激素(Free-β-HCG)、游离雌三醇(uE3)等血清生化指标检测,利用产前筛查软件评估其出生缺陷及危险性。结果血清学筛查孕妇中高风险共473例,其中21-三体综合征高风险416例,18-三体综合征高风险5例, NTD高风险52例;不同年龄区间高风险的分布比较差异无统计学意义(P>0.05);21-三体高风险、18-三体高风险及NTD高风险检出数集中分布于孕周16~19周,检出数分别为416例、5例、52例,三组检出数比较差异无统计学意义(P>0.05);筛查高风险组妊娠结局异常率3.38%(16/473),明显高于筛查低风险组的0.99%(54/5449),差异具有统计学意义(P<0.05);年龄在20~34岁孕妇出生缺陷异常率为2.03%(118/5812),低于35~41岁孕妇异常率的4.55%(5/110),差异具有统计学意义(P<0.05)。结论妊娠中期孕妇血清三联生化标记物作为21-三体综合征、18三体综合征及NTD等重要出生缺陷筛查指标,能有效降低胎儿出生缺陷发生率,对提高人口素质具有积极意义。     

High frequency of mitral valve prolapse and aortic regurgitation among asymptomatic adults with Down's syndrome

Although cardiac anomalies are well documented among children with Down's syndrome, data on the cardiac status of adults with Down's syndrome are sparse. Therefore, we performed cardiac auscultation and Doppler echocardiographic examinations in 35 asymptomatic adults with Down's syndrome. There were 25 men and ten women; their mean age (+/- SD) was 26 +/- 8 years. Only ten subjects (29%) had normal findings on examination. The most frequent abnormal findings were holosystolic mitral valve prolapse (MVP) in 20 subjects (57%) and mild aortic regurgitation in four subjects (11%). Of the 20 subjects with MVP, five had associated tricuspid valve prolapse, but none had notable mitral regurgitation. Thus, we found that the majority of asymptomatic adults with Down's syndrome had valvular heart abnormalities. The high frequency of MVP and aortic regurgitation suggests that these lesions may be specifically associated with Down's syndrome in adults.     

Live-birth rates and multiple-birth risk using in vitro fertilization

CONTEXT: To maximize birth rates, physicians who perform in vitro fertilization (IVF) often transfer multiple embryos, but this increases the multiple-birth risk. Live-birth and multiple-birth rates may vary by patient age and embryo quality. One marker for embryo quality is cryopreservation of extra embryos (if embryos are set aside for cryopreservation, higher quality embryos may have been available for transfer). OBJECTIVE: To examine associations between the number of embryos transferred during IVF and live-birth and multiple-birth rates stratified by maternal age and whether extra embryos were available (ie, extra embryos cryopreserved). DESIGN AND SETTING: Retrospective cohort of 300 US clinics reporting IVF transfer procedures to the Centers for Disease Control and Prevention in 1996. SUBJECTS: A total of 35554 IVF transfer procedures. MAIN OUTCOME MEASURES: Live-birth and multiple-birth rates (percentage of live births that were multiple). RESULTS: A total number of 9873 live births were reported (multiple births from 1 pregnancy were counted as 1 live birth). The number of embryos needed to achieve maximum live- birth rates varied by age and whether extra embryos were cryopreserved. Among women 20 to 29 years and 30 to 34 years of age, maximum live-birth rates (43 % and 36%, respectively) were achieved when 2 embryos were transferred and extra embryos were cryopreserved. Among women 35 years of age and older, live-birth rates were lower overall and regardless of whether embryos were cryopreserved, live-birth rates increased if more than 2 embryos were transferred. Multiple-birth rates varied by age and the number of embryos transferred, but not by whether embryos were cryopreserved. With 2 embryos transferred, multiple-birth rates were 22.7%, 19.7%, 11.6%, and 10.8% for women aged 20 to 29, 30 to 34, 35 to 39, and 40 to 44 years, respectively. Multiple-birth rates increased as high as 45.7% for women aged 20 to 29 years and 39.8% for women aged 30 to 34 years if 3 embryos were transferred. Among women aged 35 to 39 years, the multiple-birth rate was 29.4% if 3 embryos were transferred. Among women 40 to 44 years of age, the multiple-birth rate was less than 25% even if 5 embryos were transferred. CONCLUSIONS: Based on these data, the risk of multiple births from IVF varies by maternal age and number of embryos transferred. Embryo quality was not related to multiple birth risk but was associated with increased live-birth rates when fewer embryos were transferred.     

年轻妇女宫颈癌与HPV感染的关系

目的探讨35岁以下年轻妇女宫颈癌的发生与人乳头状瘤病毒(HPV)感染的关系。方法对1996年10月至2005年11月在我院就诊的96例宫颈癌患者的发病年龄进行分析,并对其肿瘤组织或宫颈分泌物进行HPV检测。结果35岁以下年轻妇女宫颈癌与同期宫颈癌的构成比从1996年的11%上升至2005年的42%。≤35岁宫颈癌患者的HPV阳性率为65%,较>35岁者明显升高,后者为32%。宫颈癌患者的平均发病年龄逐年减小,HPV感染率逐渐升高。结论35岁以下年轻妇女宫颈癌的发病率呈上升趋势,与HPV感染有相关性。故应加强对HPV感染高危人群的监测、随访,做好宫颈癌的早期诊断和治疗。     

围绝经期症状的影响因素分析

目的:探讨围绝经期症状的发生情况及其影响因素。方法:采用统一的调查问卷,选取郑州市第七人民医院门诊体检的40～60岁妇女进行问卷调查。结果:405名围绝经期妇女中出现第1次月经紊乱的平均年龄是(46±3.63)岁,出现第一次围绝经症状的平均年龄是(47.0±3.99)岁。本次调查的围绝经期妇女中出现围绝经期综合征的有260人,发生率为64.2%,文化程度高、专业技术人员、居住于城市、健康状况自评差是围绝经期症状的主要影响因素。结论:围绝经期症状晚于月经改变出现,围绝经期症状的发生与文化程度、职业、居住地、健康状况自评有关。     

卵丘颗粒细胞的端粒长度与体外受精-胚胎移植妊娠结局的关系

目的 颗粒细胞凋亡直接影响胚胎的质量,而端粒参与了细胞增殖的调控,因此,本文探究了卵丘颗粒细胞的端粒长度与体外受精-胚胎移植妊娠结局之间的关系,为胚胎和卵母细胞的评估提供思路。 方法 选择2015年6月—2016年12月间上午入住舟山市妇幼保健院的87例进行体外受精-胚胎移植的患者作为研究对象。所有患者根据年龄,共分为4组:20～25岁(21例);26～30岁(24例);31～35岁(23例);>35岁(19例)。依据卵母细胞成熟度,将患者分为未成熟卵泡颗粒细胞组(45例)和成熟卵泡颗粒细胞组(42例);依据胚胎移植后孕囊的阴道B超检查,分为妊娠组(43例)和非妊娠组(44例)。比较患者的年龄、卵母细胞的成熟度对卵丘颗粒细胞端粒长度,分析不同成熟度的卵母细胞卵泡液内抗苗勒管激素水平以及不同妊娠结局的卵巢颗粒细胞凋亡情况。所有数据的处理分析均使用SPSS 22.0统计软件。 结果 20～25岁组、31～35岁组和>35岁组的患者颗粒细胞端粒长度和卵泡成熟度之间有明显差异,随着年龄的增加,患者体内的成熟卵母细胞的颗粒细胞的端粒长度逐渐变短,端粒的长度与年龄呈负相关(P<0.05)。未妊娠患者与已妊娠的患者之间的颗粒细胞端粒长度比较,未妊娠的患者明显更小,差异具有统计学意义(P<0.05)。未成熟卵母细胞的卵泡液内的AMH水平明显高于成熟的卵母细胞,差异具有统计学意义(P=0.007)。比较非临床妊娠组和临床妊娠组的卵巢颗粒细胞凋亡率,差异具有统计学意义(P<0.05)。 结论 端粒长度随着患者年龄的增大而缩短,未妊娠患者的端粒长度更短,卵丘颗粒细胞的端粒长度与卵母细胞的成熟度和妊娠结局密切相关,具有临床研究价值。      

移植2个胚胎发生双胎妊娠的风险因素分析

目的 探讨1次移植2枚胚胎时发生双胎妊娠的风险因素.方法 回顾性分析2970例1次移植2个胚胎移植周期资料,其中新鲜胚胎移植周期1984例、冻融胚胎移植周期986例,应用多因素Logistic回归法分析发生双胎妊娠的风险因素,并比较年龄＜35岁和≥35岁,移植0、1、2个优质胚胎以及不同移植时机的移植周期双胎妊娠率.结果 (1)多因素Logistic回归分析发现女方年龄与双胎妊娠呈负相关(P＜0.01)、移植优质胚胎个数和冻融胚胎移植与双胎妊娠正相关(均P＜0.01);(2)新鲜胚胎移植周期和冻融胚胎移植周期的双胎妊娠率在女方年龄＜35岁组均显著高于≥35岁组(16.0％比8.0％,P＜0.01;26.9％比14.2％,P＜0.01);(3)新鲜胚胎移植周期移植2个优质胚胎的双胎妊娠率显著高于移植0个和1个优质胚胎组(19.1％比5.4％和11.0％,均P＜0.01);冻融胚胎移植周期移植2个优质胚胎的双胎妊娠率亦显著高于移植0个和1个优质胚胎组(32.7％比10.8％和20.7％,均P＜0.01);(4)冻融胚胎移植周期双胎妊娠率显著高于新鲜胚胎移植周期(24.7％比14.9％,P＜0.01).结论 女方年龄、移植优质胚胎个数和冻融胚胎移植是双胎妊娠发生的高危因素;在冻融胚胎移植技术成熟的中心,对于女方年轻的患者,在FET周期建议单优胚移植.     

Down's syndrome. Recent trends in the United States

The crude incidence of Down's syndrome (DS) in the United States is currently about 1/1,000 births. Reduction in the proportion of births to women 35 years and older can account for a halving of the estimated percentage of DS births to this age group and a drop in the estimated crude incidence of DS from 1.33/1,000 births in 1960 to 0.99/1,000 births in 1978. Epidemiologic studies suggest that among women 35 years and older, the risk of having a child with DS has not changed. With the present distribution of maternal ages, prenatal diagnosis among women 35 years and older can result in no more than a 20% decrease in the crude incidence of DS. With continued use of prenatal diagnosis among older gravidas, upward of 80% of DS births will occur to younger mothers.     

Genetic screening in Western Australia.

The wider application of genetic screening is described in four Western Australian populations. Counselling with prenatal diagnosis of Down's syndrome was offered to 57 women over the age of 35 years and less than 16 weeks' gestation who attended an antenatal outpatients department. Forty-four women consented to amniocentesis and two affected fetuses were found. Both public and private patients can be screened to detect fetuses with Down's syndrome. In a population of 200 pregnant girls whose infants were intended for adoption, a specially designed family history form aided identification of genetic disorders in 32 families. Counselling was offered to the biological parents, to the adoptive parents, and, prospectively, to the child in later years. The effectiveness of the family history as a screening device is illustrated in this adoption sample. Counselling of parents of 20 decreased malformed infants initiated the genetic counselling clinic in Western Australia and led to subsequent referral of 92 similar cases by the family doctors. It was found that parents who gave birth to malformed infants welcome information and risk figures. Diagnostic screening in a population of 6000 intellectually handicapped individuals yielded 1372 cases (23%) with Mendelian, multifactorial, or chromosomal modes of inheritance. This screening enabled patients with inherited causes for their intellectual handicap to be identified and placed on a register for health planning.     

克罗米芬联合尿促性腺素用于IVF促排卵治疗的有效性研究

目的 研究IVF治疗中克罗米芬联合尿促性腺素进行促排卵治疗的效果.方法 回顾性分析了945个患者进行的1080个周期.结果 在年龄＜35组,基础FSH为(9.3±3.9)IU/L,获卵数为(7.6±5.2)个,胚胎数为(3.6±2.9)个,优质胚胎数为(2.7±2.3)个,冷冻胚胎移植的临床妊娠率为(44.2)％.在年龄≥35岁的患者中,FSH为(10±4.3)IU/L,获卵数为(4.9±3.7)个,胚胎数为(2.3±1.9)个,优质胚胎数为(2.0±1.6)个,冷冻胚胎移植的临床妊娠率为26.5％.结论 对于基础FSH偏高或者年纪大的患者,联合克罗米芬和尿促性腺素是一种有效的促排卵方案.     

宜昌市职业人群非酒精性脂肪性肝病流行病学调查及其与代谢综合征相关性研究

目的：调查研究宜昌市职业人群中非酒精性脂肪肝（NAFLD）患病率及其与代谢综合征（MS）的关系,对本市职业人群NAFLD患病规律进行分析。方法抽样调查宜昌市城区15个单位职业人群共6450人（男3284人,女3166人）,年龄20～70岁,对其进行体格和肝区超声检查,并抽取空腹血进行葡萄糖、三酰甘油、高密度脂蛋白胆固醇、尿酸、CRP等检测,对结果进行统计分析。结果宜昌市职业人群NAFLD的患病率为21．71％,男性为28．68％,女性为14．47％（P＜0．01）。60岁以前各年龄段男性患病率明显高于女性,女性患病率与年龄呈正相关,60岁后达31．31％。NAFLD组中,MS相关组分中患病率最高的为肥胖（69．98％）、高TG血症（61．10％）。结论宜昌市职业人群中60以下男性、60岁以上女性为NAFLD患病高风险人群,该群体应作为定期监测、预防和干预的重点。MS人群中NAFLD患病率显著增高,其最重要相关因素为肥胖、高TG血症。     

高龄不孕症患者冻融胚胎移植胚胎数目和质量与早期妊娠丢失率的关系

目的 分析高龄不孕患者接受辅助生殖技术（ART）行冻融胚胎移植（FET）周期的胚胎数目和质量与早期妊娠丢失率的关系。方法 选择2015年1月~2018年12月于南方医科大学南方医院接受ART并行FET的≥36岁的不孕症患者共2622例,对妊娠的976例患者根据后续妊娠情况分为早期妊娠丢失组和持续妊娠组,分析早期妊娠丢失率与年龄、移植胚胎数、胚胎质量等的关系;根据患者年龄分为：36~37岁组、38~39岁组、40岁组、41岁组、42岁组、43岁组、44岁组和45~48岁组,进一步分析不同年龄段早期妊娠丢失率与胚胎移植数及胚胎质量的关系。结果 本研究共纳入2622例FET周期,其中临床妊娠976例,临床妊娠率37.2%（976/2622）,活产663例,活产率25.3%。临床妊娠患者中早期妊娠丢失241例,继续妊娠735例,早期妊娠丢失率24.7%（241/976）。各组患者临床妊娠率及活产率随年龄增长而降低,早期妊娠丢失率随年龄增长而显著升高（P<0.001）;早期妊娠丢失组患者FET年龄及取卵年龄均高于持续妊娠组,移植D3胚胎数高于持续妊娠组（0.97 vs 0.81,P=0.030）,着床胚胎数低于持续妊娠组（1.09 vs 1.25,P<0.001）;各年龄组早期妊娠丢失率与移植胚胎数和胚胎质量没有显著关系（P>0.05）。结论 高龄不孕女性患者冻融移植胚胎周期的早期妊娠丢失率随年龄增长而升高,年龄是导致早期妊娠丢失的无法补救的危险因素,故应对高龄不孕女性尽早实施ART助孕治疗。为降低早期胚胎丢失率,同时权衡多胎妊娠的风险,根据胚胎质量谨慎决定胚胎移植数。     

3169例孕中期孕妇产前筛查结果分析

目的分析安康地区孕中期孕妇产前唐氏综合征、18-三体综合征和神经管缺陷的筛查结果。方法选取2011年12月至2013年5月安康地区的3169例孕中期孕妇为研究对象,将其唐氏综合征、18-三体综合征、神经管缺陷高危风险比例进行统计分析,并比较其中不同年龄与孕周者的高危风险比例。结果3169例孕中期孕妇中共检出唐氏综合征高风险者96例（3．03％）,18-三体综合征高风险者30例（0．95％）,神经管缺陷高风险者32例（1．01％）,其中≤20岁及≥35岁者的总比例均高于其他年龄段,其差异均有统计学意义（P〈0．05）,而不同孕周者之间则差异无统计学意义（P〉0．05）。结论安康地区孕中期孕妇以唐氏综合征高风险比例高于18-三体综合征和神经管缺陷,且不同年龄段的差晃也较为明显。     

人类胚胎冷冻复苏影响因素分析

目的：观察患者年龄、促排卵方案、受精方式、胚龄及冻胚移植周期方案对于冷冻胚胎复苏和移植后临床妊娠的影响。方法：慢速冷冻体外受精周期中剩余的质量良好的胚胎，随后于不同周期用快速融解法复苏后进行移植。根据上述因素将患者分组，对复苏后胚胎质量和临床妊娠率进行比较。结果：126例患者中，融解胚胎总数445个，复苏后成活368个(82．7％)。获得临床妊娠48例(38．1％)。年龄对冷冻胚胎复苏率和移植后临床妊娠率的影响比较明显。随着年龄增加，冻胚移植的妊娠率下降，尤其是在35岁以后，下降更为明显。促排卵方案、受精方式、冷冻时胚胎的培养天数和移植周期方案均对冷冻胚胎复苏率和移植后临床妊娠率没有明显影响。结论：在诸多因素中，只有患者年龄会影响冻胚移植的结果。     

零污染空气净化对体外受精-胚胎移植妊娠结局的影响

目的 探索零污染空气净化系统对体外受精-胚胎移植(IVF-ET)妊娠结局的影响.方法 分别利用独立样本t检验比较我院生殖中心在应用零污染空气净化系统前(A组:尘埃及细菌滤过空气净化系统)及后(B组:零污染空气净化系统)两组周期不同年龄段(≥35岁和<35岁)的正常受精率、受精率、卵裂率、优胚率、临床妊娠率和早期流产率差异.结果 对于年龄<35岁的IVF-ET患者,应用零污染空气净化系统前后两组不孕年限、平均获卵数、优质卵数和移植胚胎数比较差异均无统计学意义(P>0.05),但实验组优胚率和卵裂率明显提高,与对照组比较差异有统计学意义(P<0.05);显著提高临床妊娠率,降低早期流产率.对于年龄≥35岁的IVF-ET患者,应用零污染空气净化系统前后两组不孕年限、平均获卵数、优质卵数、正常胚胎和移植胚胎数差异均无统计学意义(P>0.05),但实验组优胚率和卵裂率明显提高,与对照组相比差异有统计学意义(P<0.05);显著提高临床妊娠率,降低早期流产率.结论 实验室和手术室使用零污染空气净化系统能明显改善IVF-ET胚胎发育潜能,提高临床妊娠率,有效降低早期流产率.     

Effect of Patient Age and Embryo Parameters on Pregnancy Outcome in In Vitro Fertilization-Embryo Transfer （IVF-ET）

Objective To study the effect of patient age, the number and quality of embryos transferred on pregnancy outcome in in vitro fertilization-embryo transfer procedures （IVF-ETs）. Methods A retrospective study was conducted with infertile women who underwent a total of 1 800 cycles of lVF-ET and intracytoplasmic sperm injection （ICSI） at the Reproductive Medicine Center of the Third Affiliated Hospital of Guangzhou Medical College from Jan. 2006 to Dec. 2007. The patients were divided into three groups based on age （year）. 〈30, 30-34 and 235. The rates of clinical pregnancy and multiple pregnancies were compared in each group when 1-3 embryos and 0-3 goodquality embryos were transferred respectively. Results 1） In the group of patients aged 〈30 years, there was no significant difference in pregnancy outcomes with 1-3 embryos transferred. However, pregnancy rates were similar when 2 3 good-quality embryos were transferred, which was significantly higher compared with 0-1 good-quality embryos transferred; the incidence of multiple pregnancies was not an issue when only 1 embryo was transferred. 2） The pregnancy rate of the patients aged 30 34 was not significant not only when only 2-3 embryos were transferred but also when 2-3 good-quality embryos were transferred, which was significant compared with when 1 embryo or 0 1 good-quality embryo was transferred. The subgroup of 3 good-quality embryos transferred, at the same time, was expected to significantly increase multiple pregnancy rate. 3） For the patients aged 235, there were similar pregnancy rates in the subgroup involving 1-3 embryos transferred. Compared with 0-2 good-quality embryos transferred, the pregnancy rate was significantly higher in the patients with 3 good-quality embryos transferred. An increased trend toward multiple pregnancies was observed among not only the subgroups with 1-3 embryos transferred, but also when 1-3 good-quality embryos were transferred, although it was significantly higher in patients with 3 good-quality embryo transferred. Conclusion In an effort to achieve the ideal pregnancy rate without the risk of multiple pregnancies, it is desirable to employ a single good-quality embryo transfer for patients aged 〈30 years and 2 good-quality embryos for patients aged 330. As older women （aged 335 years）, this is important, need to abstain from poor-quality embryo transferred by increasing the number of embryos transferred in an effort to improve the rate of clinical pregnancy, if the patients have had enough 2 high-quality embryos.