玻璃化冷冻囊胚复苏移植与玻璃化冷冻胚胎复苏后继续培养至囊胚移植的妊娠结局比较

Comparison of the pregnancy outcome of vitrified blastocyst implantation after unfreezing and implantation of blastocyst cultured from embryo unfrozen at cleavage stage

目的比较玻璃化冷冻囊胚复苏后移植与玻璃化冷冻胚胎复苏后继续培养至囊胚移植的临床妊娠结局。方法回顾性分析2013年1月至2014年12月在郑州大学第二附属医院生殖中心行玻璃化冷冻复苏后移植囊胚的不孕症患者134例(134个周期)的妊娠情况,其中卵裂期胚胎培养至囊胚冷冻复苏后移植者79个周期(A组),卵裂期胚胎冷冻复苏后继续培养至囊胚再移植者55个周期(B组)。比较2组患者临床妊娠率、着床率及早期流产率。结果 A组79个周期,复苏囊胚数151个,存活囊胚数133个,复苏率88.08%(133/151);获得可移植囊胚72个周期,妊娠周期46个,妊娠率为63.89%(46/72),着床率51.56%(66/128),早期流产率为15.21%(7/46)。B组55个周期227个胚胎,复苏存活170个胚胎,复苏率74.89%(170/227);其中45个周期共形成可移植囊胚93个,囊胚形成率为54.70%(93/170);获得妊娠周期23个,妊娠率为51.11%(23/45),着床率为36.56%(34/93),早期流产率13.04%(3/23)。A组囊胚复苏率高于B组卵裂期胚胎复苏率(P<0.05),且A组着床率显著高于B组(P<0.05),但2组临床妊娠率、流产率、异位妊娠率比较差异均无统计学意义(P>0.05)。结论玻璃化冷冻囊胚复苏移植能获得较高的着床率和妊娠率,囊胚可能是玻璃化冷冻胚胎的较好阶段。

Objective To compare the clinical pregnancy outcome of vitrified blastocyst implantation after unfreezing and implantation of blastocyst cultured from embryo unfrozen at cleavage stage. Methods The pregnancy outcomes of 134 cases of infertility（ 134 cycles）,who underwent vitrified blastocyst implantation after unfreezing in Reproductive Medical Center of the Second Affiliated Hospital of Zhengzhou University from January 2013 to December 2014,were analyzed retrospectively. The vitrified blastocysts which developed from the embryoin cleavage stage were implanted after unfreezing in 79 cycles（ group A）. The blastocysts which developed from frozen embryo after thawing in cleavage stage were implanted after cultivation in 55 cycles（ group B）. The clinical pregnancy rate,nidation rate and early abortion rat were compared between the two groups. Results In group A（ 79 cycles）,151 blastocysts were thawed,133 blastocysts survived,the recovery rate was 88. 08%（ 133 /151）; 72 cycles of the transplantable blastocyst were obtained,and 46 pregnancy cycles were successful,the pregnancy rate was 63. 89%（ 46 /72）,the nidation rate was 51. 56%（ 66 /128）,and the early abortion rate was 15. 21%（ 7 /46）. In group B（ 79 cycles,227 embryos）,170 embryos survived after thawing,the recovery rate was 74. 89%（ 170 /227）; 93 transplantable blastocyst formed in the 45 cycles,the blastulation rate was 54. 70%（ 93 /170）; 46 pregnancy cycles were successful,the pregnancy rate was 51. 11%（ 23 /45）,the nidation rate was 36. 56%（ 34 /93）,and the early abortion rate was 13. 04%（ 3 /23）. The blastocyst recovery rate in group A was significantly higher than the cleavage stage embryo recovery rate in group B（ P〈0. 05）,and the nidation rate in group A was significantly higher than that in group B（ P〈0. 05）. There was no significant difference in clinical pregnancy rate,abortion rate and ectopic pregnancy rate（ P〈0. 05）. Conclusions The method of vitrified blastocyst implantation after unfreezing can get higher nidation rate and pregnancy rate. Therefore,blastocyst may be the best stage for vitrifying and freezing of embryo.