新鲜周期和复苏周期囊胚培养及移植的临床结局分析

Analysis of clinical outcomes of blastocyst culture and transfer between fresh cycles and vitrified-thawed cycles

目的:比较新鲜周期和复苏周期囊胚培养及移植的临床结局,探讨囊胚移植的最佳方案。方法:回顾分析2012年1月至2014年8月在郑州大学第三附属医院生殖中心行常规体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)患者的临床资料。根据培养方式分为A组(新鲜胚胎行囊胚培养后移植,58个周期)、B组(新鲜胚胎行囊胚培养冷冻复苏后移植,285个周期)和C组(冷冻胚胎复苏后行囊胚培养再移植,84个周期)。比较新鲜胚胎和冷冻胚胎复苏后的囊胚形成率及可利用囊胚形成率以及3组患者的囊胚种植率、生化妊娠率、临床妊娠率、多胎率和早期流产率等指标。结果:新鲜胚胎的囊胚形成率及可利用囊胚形成率均高于冷冻胚胎(χ2=8.561和4.037,P<0.05);3组患者的生化妊娠率、临床妊娠率及早期流产率比较差异有统计学意义(χ2=44.376、6.255和9.167,P<0.05),B组患者的生化妊娠率及临床妊娠率均高于A组,早期流产率低于A组;3组间囊胚种植率和多胎率比较差异无统计学意义(χ2=4.234、1.172,P>0.05)。结论:新鲜胚胎较冷冻胚胎有较高的囊胚形成率,新鲜囊胚冷冻后择期复苏移植能提高患者的妊娠率,是目前最佳的囊胚培养和移植方案。

Aim：To compare the clinical outcomes of blastocyst culture and transfer between fresh cycles and vitrified -thawed cycles ,so as to choose the best scheme of blastocyst transfer .Methods：Retrospective analysis of clinical data with the patients undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transplantation （ IVF/ICSI-ET ） from Jan.2012 to Aug.2014 was performed.According to the cultivating method,the patients were divided into group A （D3 embryos conducting blastocyst culture and transfer , 58 cycles）, group B （transfering the vitrified-thawed blastocyst, 285 cycles ） and group C （ vitrified-thawed embryos conducting blastocyst culture and transfer , 84 cycles ） .The blastocyst forming rate and the available blastocyst forming rate for fresh embryos （ group A and group B ） and those for vitrified-thawed embryos（group C） were compared.The indexes such as biochemical pregnancy rate , clinical pregnancy rate, blastocyst implanting rate , multiplets rate and abortion rate among the three groups were compared .Results： The blastocyst forming rate and the available blastocyst forming rate for fresh embryos were higher than those for vitrified -thawed embryos （χ2 =8.561 and 4.037,P〈0.05）;there were statistical differences in the biochemical pregnancy rate , clinical pregnancy rate and abortion rate among the three groups （χ2 =44.376,6.255 and 9.167,P〈0.05） and those for group B were improved compared with group A ,while there were no statistical differences in blastocyst planting rate or multiplets rate （χ2 =4.234 and 1.172,P〉0.05）.Conclusion： Fresh embryos have a higher blastocyst formation rate than vitrified-thawed embryos and selective vitrified-thawed blastocyst transfer can improve the pregnancy rate ,which is the best scheme for blastocyst cul-tivation and transfer currently .