姐妹胚胎囊胚形成率与卵裂期胚胎移植临床结局的相关性

Evaluation of blastulation rate of sibling embryos on predicting clinical outcomes of cleavage embryos transfer

目的探讨卵裂胚移植后剩余的姐妹(sibling)胚胎囊胚形成率对IVF-ET临床结局的预测价值及胚胎移植策略的选择。方法回顾性分析2013年1月至2014年7月在我院生殖中心实施IVF/ICSI-ET的454个移植周期的临床资料,其中,有188个周期为受精后第3天(D3)行卵裂胚移植,设为A组,有266个周期行全囊胚培养并移植优质囊胚,设为B组。A组再分为优质囊胚形成组(A1组,127个周期),无优质囊胚形成组(A2组,61个周期)。比较各组的基本资料和临床结局,直线回归分析囊胚形成率与临床妊娠率的相关性。结果 3组间年龄、不孕年限、HCG日子宫内膜厚度、平均获卵数、成熟卵数、正常受精率、卵裂率、D3优质胚胎数,优质胚胎率,移植胚胎数、异位妊娠率,流产率和周期取消率均无统计学差异(P>0.05),B组临床妊娠率(69.7%,)和种植率(40.1%)均显著高于A2组(52.5%、28.2%)(P<0.05),A1组与B组间无显著性差异(P>0.05);回归分析显示总囊胚形成率及优质囊胚形成率与临床妊娠率呈显著正相关(分别为r=0.844和r=0.867,P<0.05)。结论卵裂胚移植后姐妹胚胎囊胚形成率对IVF-ET的临床结局有预测价值,优质卵裂期胚胎移植后剩余姐妹胚胎培养形成优质囊胚可获得与移植优质囊胚相似的临床结局。

Objective：To investigate the predictive value of the blastulation rate of sibling embryos on the clinical outcomes of cleavage embryos transfer,and explore the optimum transfer strategy of good-quality cleavage embryo in IVF-ET cycle.Methods：A total of 454IVF/ICSI-ET cycles performed in the 105 th Hospital of PLA from January2013 to July 2014 were enrolled in this retrospective study.The cycles were assigned into group A（cleavage stage embryo transfer group in which surplus embryos were cultured to blastocyst,188cycles）and group B（good-quality blastocyst transfer group,266cases）.The group A was sub-divided into group A1（with good-quality blastulation）and group A2（without good-quality blastulation）.The clinical outcomes such as the rates of fertilization,embryo quality,clinical pregnancy,implantation,miscarriage,ectopic pregnancy and cycle cancellation were compared among the three groups.The correlation between the clinical pregnancy rate of the cleavage embryo transfer and blastulation rate of sibling embryos were analyzed.Results： There were no significant differences in patients＇ age,infertile duration,thickness of endometrium,average number of oocytes retrieved,number of mature oocytes,fertilization rate,cleavagerate,number of good-quality embryo on day 3,number of implantation embryos,ectopic pregnancy rate,miscarriage rate,and cycle cancellation rate among the three groups（P〈0.05）.The clinical pregnancy rate（69.7% vs.52.5%）and implantation rate（40.1% vs.28.2%）in group B were significantly higher than those in group A2（P〈0.05）,but there was no significant difference between group A1 and group B（P〉0.05）.The significant positive correlations were found between clinical pregnancy rate and total blastulation rate（r=0.844,P〈0.05）,as well as good-quality blastulation rate（r=0.867,P〈0.05）.Conclusions：The total blastulation rate and good-quality blastulation rate of sibling embryos have the predictive values for the clinical outcomes.When the remnant sibling embryos can develop to good-quality blastocyst,the clinical outcomes of good-quality cleavage embryo transfer on day 3are satisfactory as that of good-quality blastocyst transfer.