透明带激光削薄法在玻璃化冻融胚胎移植中的作用

Effect of Laser Thinning Assisted Hatching on Vitrified-warmed Embryo Transfer

目的:为探讨激光削薄法对冻融胚胎移植结局的影响。方法:选取分裂期胚胎移植组372个周期、囊胚期胚胎移植组81个周期以及反复种植失败(既往移植失败≥2次)移植组128个周期,分别按解冻单、双日将周期解冻胚胎分为激光削薄组和对照组,激光削薄组胚胎于移植前行卵透明带激光削薄处理,对照组胚胎不进行削薄处理,分析比较各组间的实验室和临床效果。结果:移植分裂期胚胎组患者的生化妊娠率、临床妊娠率及胚胎种植率激光削薄组与对照组相比无统计学差异(49.11%vs 48.28%,42.01%vs 42.36%,28.66%vs 28.35%,P>0.05);囊胚期胚胎激光削薄组患者的上述移植结局与对照组比较亦无统计学差异(60.47%vs 63.16%,48.84%vs55.26%,37.88%vs 38.57%,P>0.05);反复种植失败患者的冻融胚胎经激光削薄法处理后没有改善其妊娠结局(43.33%vs 45.59%,36.67%vs 39.71%,25.23%vs 26.15%,P>0.05),但是在囊胚期胚胎和反复种植失败患者中,患者移植后的流产率激光削薄组较对照组有增高的趋势(19.05%vs4.76%,P=0.153;36.36%vs 11.11%,P=0.035),其中反复种植失败激光削薄组显著高于对照组(P<0.05)。结论:透明带激光削薄辅助孵化技术并不能有效改善冻融胚胎移植患者的妊娠结局,其远期安全性有待于进一步研究。

Objective： To explore the effect of laser thinning assisted hatching on frozen-thawed embryo transfer outcome. Methods： Selected embryos from 372 cleavage stage embryo transfer cycles, 81 blastocyst transfer cycles and 128 repeated implantation failure cycles were processed, and divided into laser thinning group and control group respectively according to odd-numbered days and even,numbered days of embryo thawed day. The embryos in laser thinning group received laser thinning assisted hatching （AH） treatment before fertilization, and which in control group did not. The laboratory and clinical outcomes were compared between the two groups. Results： The biochemical pregnancy rate, the clinical pregnancy rate and the implantation rate in the assisted hatching cleavage stage embryo group showed no significant differences with those of the control （49.11% vs 48.28%, 42.01% vs 42.36%, 28.66% vs 28.35%, P〉0.05）; There was no statistical difference of biochemical pregnancy rate, clinical pregnancy rate and implantation rate between the assisted hatching blastocyst group and the control group （60.47% vs 63.16%, 48.84% vs 55.26%, 37.88% vs 38.57%, P〉0.05）; the application of laser assisted hatching did not improve the pregnancy outcomes of repeated implantation failure patients （43.33% vs 45.59%, 36.67% vs 39.71%, 25.23% vs 26.15%, P〉0.05）. However, in the blastocyst transfer patients and repeated implantation failure patients, there was an increasing trend of abortion rate in laser assisted hatching group （19.05% vs 4.76%, P=-0.153; 36.36% vs 11.11%, P=0.035）. Conclusion： The laser assisted hatching technique does not improve pregnancy outcomes of frozen-thawed embryo transfer patients, and its long-term safety needs further study. The clinical application of this method should be cautious.