剩余胚胎继续培养囊胚的潜在价值

Potential Value of Blastocyst Cultured ContinuaUy from Surplus Embryo

目的:探讨在新鲜周期中,经ⅣF/ICSI-ET、冷冻后的剩余胚胎在体外继续培养至囊胚的意义。方法:在新鲜周期中,将D3天发育的胚胎选择评分较高的进行移植,部分胚胎玻璃化冷冻保存后,所剩余的胚胎通过序贯微滴培养法在体外继续培养至囊胚阶段,将优质囊胚进行玻璃化冷冻。在未妊娠患者下一周期将其解冻、移植,比较同时期D3通过玻璃化冷冻解冻移植后的卵裂期胚胎与囊胚期胚胎的植入率、妊娠率、单胎率和多胎率。结果:422例不孕症患者D3天移植冷冻后剩余的胚胎1842枚形成囊胚437枚(23.72%),优质囊胚315枚(17.10%);将优质囊胚行玻璃化冷冻;其中42例患者的62枚囊胚在下一周期解冻后移植,其植入率(41.94%)极显著高于243例患者的536枚卵裂期胚胎解冻后移植的植入率(20.90%)(P<0.01);而妊娠率(54.76%)显著高于解冻后卵裂期胚胎的妊娠率(36.63%)(P<0.05);但是单胎率(71.26%vs 85.71%)和多胎率(28.74%vs 13.64%)无显著差异(P>0.05)。结论:囊胚体外培养可以筛选出具有发育潜能的剩余胚胎,最大限度地利用胚胎,从而提高可用胚胎数和临床妊娠率。

Objective;To explore the significance of in vitro blastocyst development for the surplus embryos after embryos transferred or frozen during IVF/ICSI - ET cycles.Methods;D3 unhigh quality of surplus embryos after high quality embryos transferred and vitrified freezing from IVF - ET cycles were cultured to blastocyst by the sequential method,then the high quality blastula were vitrified freezing.Its were thawed and transplanted in the next cycle of unpregnant patients,It was compared between frozen - thawed embryo of D3 cleavage stage and blastula stage about implantation rate,clinical pregnancy rate,single rate and multiples ratio.Results; A total of 1842 surplus embryos whose infertilities patients of 422 cycles were transplanted and frozen were formed 437 blastulas（23.72%）,among which 315 were high quality blastulas（17.10%）;The high quality blastulas were vitrified freezing.It were transplanted 42 cycles to frozen 62blastulas in the next cycles,the implantation rate（41.94%） was significant higher than 536 thawing frozen embryos of 243 patient transplanting in D3 cleavage stage（20.90%）（P 0.01 ）;The clinical pregnancy rate（54.76%） was higher in D3 cleavage stage（36.63%）（P0.05）;But No statistically differences existed in regard to single（71.26%vs 85.71%） and mulliples（28.74%vs 13.64%）（P 0.05 ）;Conclusion：Extending culture can sort out the embryos with development potential from those remnant embryos,maximizing the use of embryos,improving useful embroys and clinical pregnancy rate.