胚胎发育潜能低下患者的冻融策略选择

Selection of freezing and thawing strategy for the patients with low embryonic development potential

目的:比较胚胎发育潜能低下的患者在冻融周期中移植不同时期胚胎的妊娠结局,以优化其冻融策略。方法:回顾性分析2015年1月至10月于我院生殖医学中心治疗的57例常规体外受精(IVF)周期或卵胞浆内单精子注射(ICSI)周期中胚胎发育潜能低下患者的冻融周期临床资料。根据移植胚胎的时期分为分裂胚移植组(n=35)及囊胚移植组(n=22),比较两组的临床妊娠率、种植率及早期流产率。结果:冻融周期中,Day3分裂胚移植组与Day5囊胚移植组相比,临床妊娠率(65.71%vs.63.63%)和种植率(50.00%vs.52.27%)相近;早期流产率虽无统计学差异,但分裂胚移植组的早期流产率有明显高于囊胚移植组的趋势(8.7%vs.0)。结论:冻融周期中,对胚胎发育潜能低下的患者建议优选囊胚移植,以降低早期流产风险。本研究结果需扩大样本后进一步探讨,为优化冻融周期的妊娠结局提供新思路。

Objectives： To compare the pregnancy outcome of the patients with low embryonic development potential in freezing and thawing cycles after transferring different periods of embryos so as to optimize the freezing and thawing strategy. Methods： The clinical data of freezing and thawing cycle for 57 patients with low embryonic development potential who were treated from January to October 2015 at the reproductive medicine center of the Affiliated Drum Tower Hospital of Nanjing University Medical School within the period of conventional in vitro fertilization（ IVF） or the period of intracytoplasmic sperm injection（ ICSI） was retrospectively analyzed. According to the period of embryo transfer,the patients were divided into cleavage-stage embryo transfer group（ n = 35） and blastocyst transfer group（ n = 22）. Clinical pregnancy rate,implantation rate and early abortion rate of two groups were compared. Results： Compared the Day 3 cleavage-stage embryo transfer group with Day 5 blastocyst transfer group in the freezing and thawing cycles,the clinical pregnancy rate（ 65. 71% vs 63. 63%） and implantation rate（ 50. 00% vs 52. 27%） were close. Early abortion rate had no statistical difference. But the early abortion rate of the cleavage-stage embryo transfer group was obviously higher than that of the blastocyst transfer group（ 8. 7% vs0）. Conclusion： It is suggested that the patients with low embryonic development potential are optimized in terms of blastocyst transfer in the freezing and thawing cycles so as to reduce the risk of early abortion. The results of this study need to be further discussed after the number of samples is expanded,so as to provide a new train of thought for optimizing the pregnancy outcome in the freezing and thawing cycles.