姐妹胚胎体外形成囊胚的时间、数量与D3胚胎移植结局关系的研究

Explore the relationship between the developmental potential of sibling embryos to blastocyst and clinical outcome of embryo transfer on Day 3

目的探讨姐妹胚胎形成囊胚的时间、数量与D3胚胎移植结局的关系。方法回顾性分析2013年1月至2014年5月在本中心行D3移植后剩余的姐妹胚胎继续囊胚培养的患者的临床资料。根据剩余胚胎继续培养有无囊胚形成分为囊胚形成组及对照组，再根据形成囊胚的时间分为D5组、D6组以及D5和D6均有囊胚形成的D5＋D6组，比较组间的种植率、临床妊娠率和流产率；分析D3移植胚胎的种植率及临床妊娠率与姐妹胚胎体外培养形成囊胚的能力及速度的相关性；再进一步分析用于囊胚培养的非优质胚胎数≥5的周期姐妹胚胎形成囊胚的情况与移植结局的关系。结果（1）囊胚形成组与对照组的种植率（31．34％ vs．19．41％）及临床妊娠率（50．14％ vs．32．84％）均有统计学差异（P〈0．01）；D5组、D6组及D5＋D6组的种植率（分别为34．42％、29．01％、31．42％）及临床妊娠率（分别为53．27％、47．92％、50．00％）均显著优于对照组（分别为19．41％和32．84％）（P〈0．05）；D5组、D6组与D5＋D6组组间种植率及临床妊娠率均无统计学差异（P〉0．05），但D5组有升高趋势；（2）形成囊胚的个数与D3移植胚胎的种植率及临床妊娠率呈显著正相关（r=0．749，P〈0．05；r=0．752，P％0．05）；（3）非优质胚胎数≥5的周期中，囊胚形成率≥40％组的种植率及临床妊娠率均显著高于囊胚形成率20％～40％组和％20％组（43．01％ vs．29．43％vs．23．12％，P〈0．05；67．39％ vs．47．48％ vs．38．58％，P〈0．01），但3组间的流产率及多胎率均无统计学差异（P〉0．05）。结论姐妹胚胎体外形成囊胚的速度及能力可能用于预测D3移植胚胎的临床结局。

Objective. To explore the relationship between the developmental potential of sibling embryos to blastocyst and clinical outcome of embryo transfer on Day 3. Methods. The clinical data of the patients who underwent Day 3 embryos transplantation and their remaining sibling embryos were continuously cultured to blastocysts between January 2013 and May 2014 were analyzed. The patients were divided into blastocyst formation group and non-blastocyst formation group（control group）. The patients in blastocyst formation group were subdivided into Day 5 group and Day 6 group according to the time of blastocyst formation. The rates of implantation, clinical pregnancy and miscarriage were compared among the groups. The relationship between the developmental potential of sibling embryos to blastocyst and clinical outcome of D3 embryo transfer was analyzed. Results. （1）The implantation rate（31.34% vs. 19.41%0）and pregnancy rate（50.14% vs. 32.84%） were significantly different between the blastocyst formation group and control group（P〈0.01）. The implantation rate（34.42%, 29.01% and 31.42%respectively） and pregnancy rate（53.27%, 47.92% and 50.00% respectively） in Day 5,Day 6 and Day 5＋Day 6 group were significantly higher than those in control group（19.41% and 32.84% respectively）（P〈0.05）. There was no significantly difference in the implantation rate and pregnancy rate among Day 5,Day 6 and Day 5＋Day 6 groups（P〉0.05）,hut Day 5 group had a rising trend. （2）The number of blastocysts developed from Day 3 embryos was significantly positively correlated with the implantation rate（r= 0. 749, P〈0.05） and pregnancy rate（r= 0. 752, P〈 0.05）when the embryos were transferred on Day 3. （3）Among these patients with ≥5 non-top quality embryos, the clinical pregnancy rate （43.01% vs. 29.43% vs. 23.12%, P〈0.05） and implantation rate （67.39% vs. 47.48% vs. 38.58%,P〈0.01）inblastocyst formation rate ≥40% group were significantly higher than those in 20% ≤ blastocyst formation rate〈 40 % group or blastocyst formation rate〈 20 group. There were no significant differences in the clinical pregnancy rate and implantation rate among the three groups（P〉0.05）. Conclusions： The developmental potential and speed of sibling embryos to blastocyst can predict the clinical outcome of embryo transfer on Day 3.