体外受精-胚胎移植周期中不同天数和发育阶段囊胚移植妊娠结局的比较

Comparison of pregnancy outcome of blastocysts transfer with different developmental days and stages in in vitro fertilization-embryo transfer cycles

目的:寻找体外受精-胚胎移植(IVF-ET)治疗中选择合适时期和高质量囊胚进行移植的依据。方法:回顾性分析行囊胚移植的4 237例患者的临床资料,其中新鲜单囊胚移植1 574例,冻融单囊胚移植854例,新鲜双囊胚移植135例,冻融双囊胚移植1 674例。根据囊胚发育天数和发育阶段分为第5日(D5)早期组、D5扩张组、第6日(D6)早期组和D6扩张组。比较各组临床妊娠率、种植率、妊娠结局和新生儿情况等各项指标。结果:①单囊胚移植:新鲜周期D5扩张组临床妊娠率和种植率显著高于其它组,其活产率显著高于D6早期组和D6扩张组,流产率明显低于D6扩张组(P<0.05);冻融周期D5扩张组具有较高的复苏率、临床妊娠率和种植率显著高于D5早期组和D6早期组(P<0.05);②双囊胚移植:D5移植2枚扩张期囊胚的种植率显著高于D5移植2枚早期囊胚,其他各组间差异无统计学意义(P>0.05);冻融周期D5扩张组移植2枚囊胚种植率最高,且临床妊娠率显著高于D5早期组,而流产率明显低于后者,差异有统计学意义(P<0.05)。结论:对于单囊胚移植和双囊胚移植,无论新鲜周期或冻融周期,D5扩张组囊胚妊娠结局最佳。

Objective： To compare the pregnancy outcome of transferred blastocysts with different developmental days and stages in fresh and frozen-thawed cycles of IVF-ET. Methods： A retrospective analysis of 4 237 cases of blastocyst transfer patients was performed, including 1 574 cases of fresh single blastocyst transfer, 854 cases of frozen-thawed single blastocyst transfer, 135 cases of fresh double blastocyst transfer and 1 674 cases of frozen-thawed double blastocyst transfer. According to the blastocyst stage of development and the number of days, following groups were divided： D5 early group, D5 expanded group, D6 early group and D6 expanded group, and indicators in each group, including clinical pregnancy, implantation rate, pregnancy outcomes and status of newborns were compared. Results： 1） Single blastocyst transfer： clinical pregnancy rate and implantation rate of D5 expanded group in fresh cycle were significantly higher than those in other groups, and its live-birth rate was significantly higher than that of D6 early group and D6 expanded group, abortion rate was significantly lower than that in D6 expanded group （P〈0.05）; D5 expanded group in frozen- thawed cycle has a higher survival rate, and clinical pregnancy rate and implantation rate were significantly higher than those in D5 early group and D6 early group （P〈0.05）. 2） Double blastocyst transfer： the implantation rate of transplanting two D5 expanded blastocysts was significantly higher than that in transplanting two D5 early blastocysts, but there was no significant difference among the other groups in fresh cycle （P〉0.05）; the implantation rate of transplanting two D5 expanded blastocyst was the highest of all groups, and the clinical pregnancy rate was significantly higher than that in D5 transplanting two early blastocysts in frozen-thawed cycle, the difference was statistically significant, while the abortion rate was significantly lower than the latter （P〈0.05）. Conclusion： D5 expanded blastocyst can obtain the best pregnancy outcome for single and double blastocyst transfer in fresh or frozen-thawed cycles.