D3非优质胚胎的冷冻价值及其临床结局分析

Clinical value of transferring frozen-thawed Day-3 non-top quality embryo

目的分析冻融胚胎移植(FET)周期中非优质胚胎的临床结局,探讨非优质胚胎冷冻与移植的价值。方法回顾性分析202个优质胚胎及144个非优质胚胎移植周期的妊娠率、种植率的差异及影响因素,以及非优质胚胎解冻后继续培养的情况。结果与优质胚胎组相比,非优质胚胎组患者年龄[(32.08±4.39)岁vs.(30.48±4.23)岁]、胚胎解冻后培养胚胎未生长比例(26.54%vs.15.52%)显著升高,而形成囊胚的比例(0.62%vs.4.10%)、胚胎种植率(13.66%vs.30.28%)及临床妊娠率(26.67%vs.51.55%)均显著下降,差异均有统计学意义(P<0.05);135个非优质胚胎FET周期共移植胚胎322枚,5B胚胎组解冻后胚胎存活率显著高于4B组(100%vs.91.87%)(P<0.05);与4B胚胎组相比,5B胚胎组未生长胚胎的比例较低(22.86%vs.32.53%),但无统计学差异(P>0.05)。结论年龄是胚胎质量及妊娠结局的重要因素;非优质胚胎中部分胚胎具有继续发育的潜能,对于优质胚胎较少或没有剩余的患者,可考虑冷冻/移植非优质胚胎,其中5B胚胎可能更有价值。

Objective： To analyze the clinical value of transferring frozen-thawed non-top quality embryo. Methods： The data of 346 frozen-thawed embryo transfer（FET）cyctes were analyzed retrospectively. All the cycles were divided into two groups according to the quality of Day-3 embryo： top quality embryo group（202 cycle）and non-top quality embryo groups（144 cycles）. The pregnancy and implantation rate and other affecting factors were compared between the two groups. The results of non-top quality embryos after thawed and cultured were observed. Results： The age of the women in the non-top quality embryo group was significantly higher than that of the top quality group [-（32.08±4.39）vs. （30.48±4.23）years]（P〈0.05）. The undeveloped embryo rate in the non-top quality embryo group was significantly higher than that of the top embryo group （26.54% vs. 15.52%）, while the blastocyst formation rate（0.62% vs. 4.10%）, the implantation rate （13.66% vs. 30.28%）,and the clinical pregnancy rate（26.67% vs. 51.55%）were all significantly lower （P〈0.05）. In 135 FET cycles of non-top quality embryo,322 embryos were transferred. The survival rate of 5B embryos after thawing was significantly higher than that of 4B embryos（100% vs. 91.87%） （P〈 0.05）. The undeveloped embryo rate in 5B embryo group was lower than that in 4B embryo group （22.86% vs. 32.53%） ,but there was no significant difference（P〉0. 05）. Conclusions： Age is one of risk factors for embryo quality and clinical outcome of assisted reproductive technology. Some non-top quality embryos have potential to develop further. It is worthy to freeze and transfer non-top quality embryos for the patients with few or no high quality embryos,which can improve the cumulative pregnancy rate,especially for 5B embryos.