冷冻前和复苏后胚胎质量对临床结局的影响

Impact of embryo factors on clinical outcome in frozen-thawed embryo transfer cycles

目的将复苏后胚胎按冷冻前是否含有优胚和/或是否同冻存时分组,比较他们的妊娠结局,探讨是冷冻前的胚胎质量还是复苏后胚胎是否同冻存时,对妊娠结局的影响更大。方法本中心2008.01-2010.12期间促排获得胚胎并冻存,患者年龄<35岁,复苏并移植2枚胚胎的683周期,共分四组:A组同冻存时,≥1枚优胚;B组同冻存时,0枚优胚;C组≥1枚有球溶解可用胚,≥1枚冻前优胚;D组≥1枚有球溶解可用胚,0枚冻前优胚。分析各组妊娠率、多胎率的差异。结果总复苏率94.08%,冻前优胚复苏率98.01%(395/403),高于冻前非优胚复苏率92.56%(971/1049),P<0.01。A组比B组、A比D组、A+C组比B+D组妊娠率高(P<0.01),C组比B组妊娠率高(P<0.05),多胎率没有统计学差异;A组比C组、B组比D组、A+B组比C+D组的妊娠率、多胎率都没有统计学差异。结论冷冻前胚胎质量比复苏后胚胎是否同冻存时对妊娠结局有更大影响。

Objective ： To investigate the influence of post - thaw survival rate or pre - freeze embryo qulity and clinical pregnancy rate in frozen - thawed embryo transfer program （FET）. Methods ： A total of 683 FET of the patients aged 〈 35 years and who were only transferred 2 embryos in a cycle were analyzed retrospectively from Jan 2008 to Dec 2010. Cases were divided into 4 groups according to the pre - freeze embryo qulity and post - thaw survival rate （ Group A ： fully intact embryos and ≥ 1 pre - freeze high - qulity embryo, Group B ： fully intact embryos and no pre - freeze high - qulity embryo, Group C ： post - thaw damaged embryos and ≥ 1 pre - freeze high -qulity embryo, Group D： postthaw damaged embryos and no pre -freeze high -qnlity embryo）. And clinical pregnancy rate and multiple pregnancy rate were compared between groups. Results： There was no significant difference in the clinical pregnancy rate and multiple pregnancy rate between Group A and Group C, or Group B and Group D, or Group A ＋ B and Group C ＋ D. But there was a significantly higher pregnancy rate in Group A and Group C （A vs. B, A vs. D, A＋C vs. B ＋D, P〈O. 01; C vs. B, P〈0.05）. Conclusions ： If there was any pre - freeze high - qulity embryo in the post - thaw embyos, they will have a higher pregnancy rate.