人类发育欠佳胚胎在卵裂期及囊胚期移植后的临床结局比较

Comparative analysis of clinical outcomes of suboptimal human embryos transferred at cleavage or blastocyst stage

目的比较分析人类体外受精后的发育欠佳胚胎,行卵裂期移植或囊胚培养后,哪一种策略更有利于改善患者的临床结局。方法患者入选标准:体外受精第3天(d3)所有胚胎均为发育欠佳胚胎(胚胎卵裂球数<6-细胞,或胚胎碎片为10%～20%)。将患者随机分为两组:卵裂期移植组(n=114)及囊胚培养组(n=106)。比较两组间的临床妊娠率、继续妊娠率及植入率。结果卵裂期移植组与囊胚培养组的移植周期临床妊娠率(38.6%vs 24.5%)、继续妊娠率(35.1%vs 24.5%)及植入率(24.5%vs 17.9%)差异均无统计学意义。由于囊胚培养组具有较高的周期取消率(53.8%),卵裂期移植组的取卵周期临床妊娠率显著高于囊胚培养组(38.6%vs 11.3%)。结论人类发育欠佳胚胎在卵裂期进行移植更加适合。

【Objective】 To analyze whether cleavage stage transfer or blastocyst culture of morphologically suboptimal human embryos can improve clinical outcomes.【Methods】 The inclusion criteria were patients who had only suboptimal embryos（all embryos were less than 6-cell stages or embryo fragments were 10~20% on day 3（d3）.Patients were assigned randomly into cleavage stage transfer group（n =114） and blastocyst culture group（n =106）.Clinical pregnancy,ongoing pregnancy and implantation rate were compared between the groups.【Results】 No significant difference was found in clinical pregnancy（38.6% vs 24.5%）,ongoing pregnancy（35.1% vs 24.5%） and implantation rate（24.5% vs 17.9%） per embryo transfer cycle between cleavage stage transfer group and blastocyst culture group.Because of high cycle cancellation rate in blastocyst culture group（53.8%）,clinical pregnancy rate per oocyte retrieval cycle was significantly higher in cleavage stage transfer group than in blastocyst culture group（38.6% vs 11.3%）.【Conclusion】 Cleavage stage transfer is more reasonable for morphologically suboptimal human embryos.