Nghiên cứu kết quả chuyển phôi trữ lạnh các trường hợp chuyển phôi tươi không thành công

B GIO DC V O TO B Y T TRNG I HC Y H NI TRNH VN DU NGHIấN CU KT QU CHUYN PHễI TR LNH CC TRNG HP CHUYN PHễI TI KHễNG THNH CễNG LUN VN THC S Y HC H NI 2017 B GIO DC V O TO B Y T TRNG I HC Y H NI TRNH VN DU NGHIấN CU KT QU CHUYN PHễI TR LNH CC TRNG HP CHUYN PHễI TI KHễNG THNH CễNG Chuyờn ngnh: Sn Ph Khoa Mó s: 60720131 LUN VN THC S Y HC Ngi hng dn khoa hc TS H S HNG H NI 2017 Lời Cảm Ơn Trong quỏ trỡnh hc tp, nghiờn cu v hon thnh lun ny, tụi ó nhn c nhiu s giỳp ca thy cụ, bn bố, ng nghip Vi lũng bit n sõu sc, tụi xin chõn thnh cm n: Ban giỏm hiu, Phũng sau i hc, B mụn Ph Sn Trng i Hc Y H Ni Ban giỏm c bnh vin, Trung tõm H tr sinh sn, Phũng K hoch tng hp - Bnh vin Ph Sn Trung ng ó to iu kin thun li cho tụi quỏ trỡnh hc v nghiờn cu Tụi xin t lũng kớnh trng v bit n ti: Tin s H S Hựng, Phú Giỏm c Trung Tõm H Tr Sinh Sn, B mụn Ph Sn trng i Hc Y H Ni, ngi thy kớnh yờu ó dỡu dt, giỳp , hng dn tụi sut quỏ trỡnh hc v nghiờn cu Cỏc Giỏo s, Phú giỏo s, Tin s hi ng khoa hc thụng qua cng, hi ng khoa hc bo v lun ó úng gúp nhiu ý kin quý bỏu cho tụi quỏ trỡnh nghiờn cu, hon chnh lun tt nghip thc s y khoa Tp th cỏn b nhõn viờn Trung Tõm H Tr sinh sn Bnh vin Ph sn Trung ng, c bit l cỏc cỏn b phũng lu tr H S ó to iu kin cho tụi quỏ trỡnh hc v nghiờn cu lun Cui cựng tụi xin by t lũng bit n ti cha m, v con, anh ch em gia ỡnh, bn bố ng nghip ó ng viờn, chia s vi tụi sut quỏ trỡnh hc v nghiờn cu Xin trõn trng cm n! H Ni, ngy 30 thỏng 08 nm 2017 Trnh Vn Du LI CAM OAN Tụi l Trnh Vn Du hc viờn cao hc khoỏ XXIV, chuyờn ngnh Sn ph khoa, Trng i hc Y H Ni xin cam oan: õy l Lun bn thõn tụi trc tip thc hin di s hng dn ca TS H S Hựng Cụng trỡnh nghiờn cu ny khụng trựng lp vi bt k nghiờn cu no khỏc ó c cụng b ti Vit Nam Cỏc s liu v thụng tin nghiờn cu l hon ton chớnh xỏc, trung thc v khỏch quan, ó c xỏc nhn v chp nhn ca c s ni nghiờn cu Tụi xin hon ton chu trỏch nhim trc phỏp lut v nhng cam kt ny H Ni, ngy 30 thỏng nm 2017 Hc viờn Trnh Vn Du DANH MC CC CH VIT TT ASRM: American Society Reproductive Medicine (Hi y hc sinh sn M) CI: Confidence Interval (Khong tin cy) ESHRE: European Society of Human Reproduction and Embryology (Hip hi sinh sn v phụi ngi chõu u) FSH: Follicle-Stimulating Hormone (Hormon kớch thớch nang noón) FET: Frozen embryo transfers (Chuyn phụi tr lnh) GnRH: Gonadotropin Releasing Hormon (Hormon gii phúng) GIFT Gamete intrafallopian transfer (Chuyn phụi vo vũi t cung) hCG: human Chorionic Gonadotropin (Hormon rau thai ngi) HTSS: H Tr Sinh Sn ICSI: Intra Cytoplasmic Sperm Injection (Tiờm tinh trựng vo bo tng noón) ICMART: International Committee Monitoring Assisted Reproductive Technologies ( y ban quc t theo dừi k thut h tr sinh sn) IVF: In Vitro Fertilisation (Th tinh ng nghim) IU: International Unit (n v quc t) KTBT: Kớch thớch bung trng OR: Odd Ratio (T sut chờnh) QKBT: Quỏ kớch bung trng TTTON: Th tinh ng nghim VS: Vụ sinh WHO: World Health Organization (T chc Y t Th gii) MC LC DANH MC BNG T VN Vụ sinh l gõy nh hng n khong 8-12% cỏc cp v chng trờn ton th gii i vi nhiu cp v chng õy l nguyờn nhõn gõy thng tn tõm lý cho h sut i [26],[27],[37] Nhiu phng phỏp nghiờn cu v iu tr vụ sinh c y hc phỏt trin cho n ngy nay, mt s ú l phng phỏp th tinh ng nghim (TTTON), mang li hnh phỳc cho rt nhiu cp v chng vụ sinh TTTON l phng phỏp c nghiờn cu v phỏt trin bi Robert Edwards t 1950 cho n a tr u tiờn i bng phng phỏp ny nm 1978 ti Vng Quc Anh [1],[2] Ngy TTTON c s dng iu tr vụ sinh ti gn 200 quc gia trờn th gii vi nhiu k thut mi giỳp tng ang k hiu qu iu tr [3] Trong TTTON ngi ta s dng cỏc phỏc kớch thớch bung trng cú kim soỏt giỳp to thnh nhiu phụi t ú ci thin t l thnh cụng ca mt chu k iu tr Thụng thng cỏc chu k chuyn phụi ti ngi ta la chn cỏc phụi tt chuyn, s phụi d c tr lnh Cỏc phụi tr lnh cn phi m bo cht lng ớt nht t trung bỡnh tr lờn vỡ phụi cht lng kộm s b thoỏi húa quỏ trỡnh tr lnh ró ụng phụi [5] Gn õy cú xu hng chuyn phụi tr lnh thay vỡ chuyn phụi ti Ngi ta cho rng chu k chuyn phụi ti, nng cỏc hormone tng cao hn bỡnh thng, c bit l nng estradiol v progesterone, lm nh hng ti s lm t ca phụi, dn n tht bi ca chuyn phụi ti, t l cú thai gim iu ny c chng minh rừ nht cỏc trng hp quỏ kớch bung trng nng, thng c ch nh tr lnh phụi ton b Cỏc bnh nhõn ny trỡ hoón chuyn phụi va lm gim nguy c quỏ kớch bung trng tin trin nng, va lm tng t l cú thai chu k chuyn phụi tr lnh Trong mt chu k chuyn phụi ti nguyờn nhõn tht bi cũn liờn quan n 10 nhiu yu t khỏc nh tui m, nguyờn nhõn vụ sinh, thi gian vụ sinh, s ngy dựng FSH, ton trng ngi bnh trc chuyn phụi, cht lng noón bo, cht lng phụi, s lng phụi chuyn [12] Ti Vit Nam chỳng ta ó t c nhiu thnh cụng lnh vc iu tr vụ sinh s dng k thut TTTON k t a tr u tiờn i bng phng phỏp ny ti bnh vin Ph Sn T D nm 1997 Nh mt xu hng phỏt trin tt yu ca cỏc trung tõm h tr sinh sn trờn th gii, phng phỏp tr lnh phụi c ỏp dng ti Vit Nam thỏng 03/2002 v trng hp thai lõm sng u tiờn c ghi nhn vo thỏng 5/2002 [4] Ti Trung tõm h tr sinh sn Quc Gia Bnh vin ph sn Trung ng phng phỏp tr lnh - ró ụng v chuyn phụi tr lnh c ỏp dng t nm 2003 T l thnh cụng ca chuyn phụi tr lnh ti bnh vin ph sn Trung ng dao ng t 22,2% - 22,8% Trong ú ngun phụi cho chuyn phụi tr lnh ch yu l phụi d ca chu k chuyn phụi ti khụng thnh cụng trc ú [11] tỡm hiu lý chuyn phụi ti tht bi v ỏnh giỏ t l thnh cụng ca chuyn phụi tr lnh cỏc trng hp chuyn phụi ti khụng thnh cụng, chỳng tụi tin hnh nghiờn cu ti: Nghiờn cu kt qu chuyn phụi tr lnh cỏc trng hp chuyn phụi ti khụng thnh cụng vi 02 mc tiờu sau: Nhn xột c im v mt s yu t liờn quan chu k chuyn phụi ti khụng thnh cụng ỏnh giỏ kt qu chuyn phụi tr lnh cỏc trng hp chuyn phụi ti khụng thnh cụng 81 KHUYN NGH Qua kt qu nghiờn cu thu c chỳng tụi cú cỏc kin ngh sau: Nờn chuyn phi tr lnh trờn nhng bnh nhõn cú niờm mc t cung thuc nhúm 8-14mm v cú hỡnh nh lỏ TI LIU THAM KHO The Nobel Prize in Physiology of Medicine (2010) PRESS RELEASE 10(04), pp: 1-2 M.S Kupka, A.P Ferraretti, J de Mouzon, et al (2014) Assisted reproductive technolo gy in Europe, 2010: results generated from European registers by ESHRE, Human Reproduction, Vol.29, No.10 pp 2099 2113 ng Quang Vinh, Vng Th Ngc Lan, Phựng Huy Tuõn, v cng s (2002) Trng hp cú thai lõm sng u tiờn t phụi ngi ụng lnh Tp Thụng tin Y Dc, s 12, trang 13-21 Zeilmaker GH, Alberda AT, van Gent I, Rijkmans CM, Drogendijk AC (1984) Two pregnancies following transfer of intact frozen-thawed embryos Fertil Steril Aug;42(2):293-6 Fritz MA, Speroff L (2011) Induction of ovulation Clinical gynecology endocrinology and infertility Lippincott Williams and Wilkins, Philadelphia, USA, 1293-1330 A Wang, D Healy, D Black and E.A Sullivan (2008) Age-specic success rate for women undertaking their rst assisted reproduction technology treatment using their own oocytes in Australia, 2002 2005, Human Reproduction Vol.23, No.7 pp 1633 1638 Sesh Kamal Sunkara, Vivi an Rittenb erg , Nick Raine-Fenning, Siladitya Bhattacharya, Javier Zam ora, and Arri Coomarasamy (2011) Association between the num ber of eggs and live birth in IVF treatment:an analysis of 400 135 treatment cycles Human Reproduction, Vol.26, No.7 pp 1768 1774 MH van der Gaast, MJC Eijkemans, JB van der Net, EJ de Boer, CW Burger, FE van Leeuwen, BCJM Fauser, NS Macklon (2006) Optimum number of oocytes for a successful rst IVF treatment cycle Reproductive BioMedicine Online Vol 13 No pp 476-480 Siladitya Bhattacharya, Abha Maheshwari, Jill Mollison (2013) Factors Associated with Failed Treatment: an Analysis of 121,744 Women Embarking on Their First IVF Cycles, PLOS ONE December, Volume 8, Issue 12, pp: 82249 10 Phm Th Thanh Lan, Nguyn Vit Tin, V Vn Tõm (2015) ỏnh giỏ cht lng phụi sau ró ụng v t l cú thai sau chuyn phụi ngy v ngy ụng lnh bng phng phỏp thy tinh húa Tp chý Nghiờn cu Y Hc, s 95, trang 15-23 11 Nguyn Vit Tin (2013) Cỏc quy trỡnh chn oỏn v iu tr vụ sinh, Nh xut bn Y Hc, trang 262-277 12 G.M.Hartshorne, K.Wick, K.Elder and H.Dyson (1990) Effect of cell number at freezing upon survival andviability of cleaving embryos generated from stimulated IVF cycles, Human Reproduction vol.5, no.7 pp: 857-861 13 Andres Salumets, Anne-Maria Suikkari, Sirpa Mọkinen, Helle Karro, Anu Roos and Timo Tuuri (2006) Frozen embryo transfers: implications of clinical and embryological factors on the pregnancy outcome, Human Reproduction Vol.21, No.9 pp: 23682374 14 Zdravka Veleva, Aila Tiitinen, Sirpa Vilska, et al (2008) High and low BMI increase the risk of miscarriage after IVF/ICSI and FET Human Reproduction Vol.23, No.4 pp: 878884 15 Seyedeh Zahra Masoumi, Parisa Parsa, Nooshin Darvish, et al (2015), An epidemiologic survey on the causes of infertility in patients referred to infertility center in Fatemieh Hospital in Hamadan, Iran J Reprod Med, Aug; 13(8) pp: 513516 16 Samuel Santos-Ribeiro, Johannie Siffain, Nikolaos P Polyzos, et al (2015) To delay or not to delay a frozen embryo transfer after a failed fresh embryo transfer attempt? Fertility and Sterility Available online 21 January 2016 17 L.F Doherty, J.R Martin, U Kayisli, D Sakkas, P Patrizio (2014) Fresh transfer outcome predicts the success of a subsequent frozen transfer utilizing blastocysts of the same cohort Reproductive BioMedicine Vol 28, pp: 204 208 18 Zdravka Veleva, Mauri Orava, Sinikka Nuojua-Huttunen, et al (2013) Factors affecting the outcome of frozenthawed embryo transfer Human Reproduction, Vol.28, No.9 pp: 2425 2431 19 Bo Huan, Dan Hu, Kun Qian, Jihui Ai, Yufeng Li, Lei Jin, Guijin Zhu, and Hanwang Zhang (2014) Is frozen embryo transfer cycle associated with a significantly lower incidence of ectopic pregnancy? An analysis of more than 30,000 cycles, Fertster, Volume 102, Issue 5, Pages 1345 1349 20 Nguyn Khc Liờu (2006) i cng v vụ sinh, Bi ging Sn-Ph khoa, Nh xut bn Y Hc, tr: 219-226 21 The International Committee for Monitoring Assisted Reproductive Technology (ICMART) and the World Health Organization (WHO) Revised Glossary on ART Terminology (2009) Human Reproduction, Vol.24, No.11 pp 26832687 22.Boyle K.E, Vlahos N, Jarow J.P (2004) Assisted reproductive rechnology in the new millennium: part I Urology Jan; pp 63:2-6 23 Fuentes, A and Devoto, L(1994) Infertility after years of marriage: a pilot study Human Reproduction Vol9 No(2): pp.273-278 24 UNDP/UNFPA/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (2003) Assisted reproduction in developing countriesfacing up to the issues, Progress, No 63, page 1-2 25 Carolyn, B, Julia, KW (2007) Psychiatric issues of infertility & infertility treatments Primary Psychiatry vol 14/2017, pp: 59-65 26 Lờ Th Hng Nhung (2014) Phn ng tõm lý khỏc gia nam v n vi vụ sinh Ni san Y Hc Sinh Sn s 32, trang 59-64 27 V Nht Khang (2010) nh ngha cỏc thut ng thng dựng h tr sinh sn, Ni san Y Hc Sinh Sn , s 16/2010 trang 5-11 28 Human Fertilisation and Embryology Authority of UK (2013) Fertility treatment in 2013: trends and figures, page 29 Wright, C V., Chang, J., Jeng, G., & Macaluso, M (2008) Assisted Reproductive Technology Surveillance: United States, 2005 MMWR Surveillance Summaries June 20 / 57(SS05);1-23 pp 1-23 30 Andersen, A N., Goossens, V., Ferraretti, A P., Bhattacharya, S., Felberbaum, R., de Mouzon, J(2008) Assisted reproductive technology in Europe, 2004: Results generated from European registers by ESHRE Hum Reprod, vol23/2008 No4, page.756-771 31 Centers for Disease Control and Prevention, American Society for Reproductive Medicine, Society for Assisted Reproductive Technology (2012) Assisted Reproductive Technology Fertility Clinic Success Rates Report Atlanta (GA): US Dept of Health and Human Services; page 23 32 Nguyn Khc Liờu (2003) i cng v vụ sinh, sinh lý kinh nguyt, thm dũ ni tit n: Chn oỏn v iu tr vụ sinh, Vin BVBMTSS, NXB y hc, tr 222 - 234 33 Phan Trng Duyt (2001) Th tinh ng nghim NXB y hc, tr 8-12, 53-69, 75-76,155 34 Andrology Australia Association (2014) MALE INFERTILITY 4th Edition, November, page 19-33 35 Thomas J Bader (2005) OB/GYN SECRETS Updated 3rd Edition Elsevier Inc Publisher, page 86-87 36 World Health Organisation Infertility A tabulation of available data on prevalence of primary and secondary infertility Geneva, WHO Programme on Maternal and Child Health; 1991 37 Tracey Bushnik, Jocelynn L Cook, A Albert Yuzpe, Suzanne Tough, and John Collins (2012) Estimating the prevalence of infertility in Canada Human Reproduction, Vol.27/2012, No.3 pp 738746 38 Larsen U (2000) Primary and secondary infertility in sub-Saharan Africa International Journal of epidemiology, Vol 29(2), page 285-291 39 Thonneau P, Marchand S, Tallec A et al (1991) Incidence and main causes of infertility in a resident population (1,850,000) of three French regions (1988 1989) Hum Reprod, 6, 811816 40 S Rutstein and I Shah (2004) Infecundity, Infertility, and Childlessness in Developing Countries, DHS Comparative Reports No.9, ORC Macro and the World Health Organization, Calverton, Md, USA 41 Hala Mahmoud Obeidat, Adlah M Hamlan, Lynn C lark Callister (2014) Missing Motherhood: Jordanian Womens Experiences with Infertility Advances in Psychiatry, Hindawi Publishing Corporation, Volume 2014, Article ID 241075, pp: 42 M.C.InhOrn, Z.b.Gỹrtin (2012) Infertility and Assisted Reproduction in the Muslim Middle East: Social, Regilious, and Resource Considerations FVV in ObGyn, 2012, MonoGraph: 24-29 43 Trn Th Chung Chin, Trn Vn Hanh, Phm Gia Khỏnh, Lờ Vn V (2002) Nghiờn cu mt s vụ sinh nam gii v la chn k thut lc ra, l tr tinh trựng iu tr vụ sinh ti cp nh nc 44 Nguyn Vit Tin, Ngụ Vn Ton, Bch Huy Anh (2010) T l hin mc vụ sinh v mt s yu t nh hng, Tp nghiờn cu Y Hc 70(5), 2010, trang 114 122 45 Bhattacharya.S, M.Porter, E.Amalraj, et al (2009) The epidemiology of infertility in the North East of Scotland Hum Reprod Advance Access published online on August 14, 2009 46 Trn Th Phng Mai, Nguyn Th Ngc Phng, Nguyn Song Nguyờn v cng s (2007) Him mun, vụ sinh v k thut h tr sinh sn NXB y hc, tr 185-190;288 297; 208 215 47 Nguyn Xuõn Hi, Phan Trng Duyt (2010) Cỏc yu t nh hng n t l cú thai lõm sng v t l lm t h tr sinh sn Tp nghiờn cu Y Hc, 69(4) 2010, tr 59-64 48 Veeck LL(1998) Oocyte assessment and biological performance Annals of the New York Academy of Sciences 1988; 541: pp 259 274 49 Alpha Scientists in Reproductive Medicine and ESHRE Special Interest Group of Embryo (2011) The Istabul consensus workshop on embryo assessment proceedings of an expert meeting Human Reproduction 2011; 26 (6): page 1270-1283 50 B Y T (2012) Quy trỡnh k thut th tinh nhõn to v th tinh ng nghim Thụng t s 12/2012/TT-BYT ngy 15/7/2012 ca B Y t 51 Janes McK Talbot and Lawrence M (1997) Invitro fertilization: indication, stimulation and clinical techniques 52 Evers, J.L (2002) Female subfertility Lancet 360, page 151159 53 Macaldowie A, Wang YA, Chambers GM et al (2012) Assisted reproductive technology in Australia and New Zealand 2010 Assisted reproduction technology series no 16 Cat no PER 55 Canberra: AIHW Page 15, 21 54 Nguyn Xuõn Huy (2004) "Nghiờn cu kt qu ca th tinh ng nghim ti Bnh vin ph sn trung ng nm 2003" Lun tt nghip bỏc s chuyờn khoa cp 2, trng i hc Y H Ni: tr 3-52 55 American Society for Reproductive Medicine - ASRM (2012) Endometriosis and infertility: a committee opinion Fertility and Sterility Vol.98 No / September 2012, page 591- 598 56 Katayama KP, Stehlik J, Kuwayama M et al (2003) High survival rate of vitrified human oocytes results in clinical pregnancy Fertility and Sterility 80, 223224 57 Masashige Kuwayama, Gỏbor Vajta, Shoko Ieda, et al (2005) Comparison of open and closed methods for vitrification of human embryos and the elimination of potential contamination RBMOnline - Vol 11 No 2005 608614 58 Cooper TG, Noonan E, Von Eckardstein S, et al (2010) World Health Organization reference values for human semen characteristics Hum Reprod Update 2010 May-Jun;16(3):231-45 59 Kennedy S, Bergqvist A, Chapron C, et al ESHRE guideline for the diagnosis and treatment of endometriosis Hum Reprod 2005; 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281(4) pp: 747-752 82 P.E.Levi Setti, R.D.Cesare, L.Sacchi, et al (2013), Elevated progesterone levels on the day of hcg administration have no influence on pregnancy and implantation rates: restrospective analysis of 5258 cycles Fertil&Steril, octember 17, pp 1098 83 Simon.C, et al (1998), Increasing uterine receptivity by decreasing estradiol levels during the preimplantation period in high responders with the use of a follicle-stimulating hormone step-down regimen, Fertil Steril, 70, (2), pp: 234-9 84 Hadi F H, et al (1994), Ovulation induction and endometrial steroid receptors, Hum Reprod, 9, (12), pp: 2405-10 85 Levi A J, et al (2001), Controlled ovarian hyperstimulation does not adversely affect endometrial receptivity in in vitro fertilization cycles, Fertil Steril, 76, (4), pp: 670-4 86 Jones, H W (1983), The importance of the follicular phase to success and failure in in vitro fertilization, Fertil & Steril, 40, (3), pp: 317-321 87 Nguyn Duy Ti, Vừ Thnh Liờn Anh (2009) Giỏ tr nng nh Estradiol nhng chu k kớch thớch bung trng th tinh ng nghim, Tp Y Hc TP H Chớ Minh, Vol 13 S 1, trang: 165 169 88 N Siddhartha, N Sanjeeva Reddy, Monna Pandurangi, et al (2016), Correlation of serum estradiol level on the day of ovulation trigger with the reproductive outcome of intracytoplasmic sperm injection, J Hum Reprod Sci Jan-Mar; 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Human Reproduction, vol.14 no.3 pp.590592 PHIU THU THP S LIU NGHIấN CU I PHN HNH CHNH H tờn bnh nhõn: Tui: S h s TTTON: in thoi: a ch: CC YU T LIấN QUAN CA CHU K CHUYN PHễI TI Thi gian vụ sinh: Loi vụ sinh: Vụ sinh I Vụ sinh II S chu k TTTON: ln dy niờm mc t cung chuyn phụi ti: mm Phỏc kớch trng: Liu FSH u: Tng liu FSH: S ngy dựng FSH: S phụi chuyn chu k ti: 10 Cht lng phụi chuyn chu k ti: 1: 2: 3: 4: 11 Ngy chuyn phụi ti: 12 Ngy ụng phụi: 13 Tui phụi ụng phụi: Ngy 2: Ngy 3: Ngy 4: Ngy 5: 14 Thi gian ụng phụi: 15 Ngy u b kinh ca chu k PET: II S ngy dựng estrogen chun b niờm mc t cung: Ngy ró ụng: Ngy chuyn phụi tr: Thi gian ụng phụi: NGUYấN NHN Vễ SINH Ri lon phúng noón: Tinh dch bt thng: Do vũi t cung: Do c hai v chng: Do lc ni mc t cung Khụn g rừ nguyờn nhõn: 16 17 18 19 III IV K THUT H TR IVF/ICSI IVF/PESA/ICSI V CHT LNG PHễI TRONG CHU K PET Trc chuyn phụi tr: 1: 2: 3: 4: VI CC THễNG S CHUNG V PHễI TRONG CHU K FET S lng phụi ụng: S lng phụi ró ụng: S lng phụi sng sau ró ụng: S lng phụi chuyn: VII VIII NIấM MC T CUNG Hỡnh thỏi niờm mc: Ba lỏ: Khỏc: dy: mm KT QU CHUYN PHễI TR Cú thai sinh húa: Cú tỳi i trờn siờu õm: Cú thai lõm sng: Ngng chu k: Khụng kt qu: ... kỳ chuyển phôi tươi không thành công trước [11] Để tìm hiểu lý chuyển phôi tươi thất bại đánh giá tỷ lệ thành công chuyển phôi trữ lạnh trường hợp chuyển phôi tươi không thành công, tiến hành nghiên. .. cứu đề tài: Nghiên cứu kết chuyển phôi trữ lạnh trường hợp chuyển phôi tươi không thành công với 02 mục tiêu sau: Nhận xét đặc điểm số yếu tố liên quan chu kỳ chuyển phôi tươi không thành công. ..BỘ GIÁO DỤC VÀ ĐÀO TẠO BỘ Y TẾ TRƯỜNG ĐẠI HỌC Y HÀ NỘI TRỊNH VĂN DU NGHIÊN CỨU KẾT QUẢ CHUYỂN PHÔI TRỮ LẠNH CÁC TRƯỜNG HỢP CHUYỂN PHÔI TƯƠI KHÔNG THÀNH CÔNG Chuyên ngành: Sản Phụ Khoa Mã