玻璃化冷冻D3卵裂期胚胎复苏后培养至囊胚移植与冷冻囊胚的临床结局比较

Comparison of clinical outcomes of blastocyst implantation by culture after vitrified frozen D3 cleavage embryo recovery and frozen blastocyst

目的比较玻璃化冷冻D3卵裂期胚胎复苏后继续序贯培养至囊胚移植与玻璃化冷冻囊胚的临床结局。方法回顾性分析该院生殖中心2015年4月至2017年4月完成的囊胚移植周期158例,其中玻璃化冻融囊胚复苏后移植109个周期(A组),玻璃化冷冻D3卵裂期胚胎复苏行序贯培养至囊胚后再移植49个周期(B组),比较两组种植率、临床妊娠率、异位妊娠及早期流产率等指标。结果A组109个周期中196枚囊胚复苏,168枚囊胚存活,复苏率为85.71%(168/196),获得可移植囊胚101个,种植率为39.39%(65/165),49个周期获得临床妊娠,临床妊娠率为48.51%(49/101),早期流产率为10.20%(5/49)。B组49个周期中D3卵裂期胚胎175枚,167枚D3卵裂期胚胎复苏存活,复苏率为95.43%(167/175);其中40个周期共形成囊胚69枚用于移植,有9个周期未形成囊胚而取消移植,囊胚形成率为41.32%(69/167),种植率为31.88%(22/69),获得临床妊娠周期18个,妊娠率为45.00%(18/40),早期流产率为11.11%(2/18)。A组囊胚复苏率明显低于B组D3卵裂期胚胎复苏率,差异有统计学意义(P<0.05);两组种植率、临床妊娠率、早期流产率、异位妊娠率比较,差异均无统计学意义(P>0.05)。结论囊胚可能是玻璃化冷冻胚胎的较好阶段,玻璃化冷冻囊胚复苏移植能获得较高的妊娠率,但D3卵裂期胚胎冻融后体外序贯培养至囊胚阶段移植需紧密结合临床实际情况谨慎开展。

Objective To compare the clinical outcomes of blastocyst implantation by continuously sequential culture after vitrified frozen D3 cleavage embryo recovery and vitrified frozen blastocyst. Methods One hundred and fifty-eight cases of completed blastocysts implantation cycle in our center from April 2015 to April 2017 were analyzed retrospectively,including 109 cycles of frozen-thawing vitrified frozen blastocyst implantation（group A） and 49 cycles of blastocysts implantation by sequential culture after vitrified frozen D3 cleavage embryo recovery. The implantation rate,clinical pregnancy rate,ectopic pregnancy and early abortion rate were compared between the two groups. Results In 109 cycles of the group A,196 blastocysts were thawed,168 blastocysts survived,the recovery rate was 85.71%（168/196）,101 blastocyst cycles obtained transfer,the implantation rate was 39.39%（65/165）,the clinical pregnant rate was 48.51%（49/101） and the early abortion rate was 10.20%（5/49）. In 49 cycles of the group B,there were 175 D3 cleavage embryos,167 D3 cleavage embryos survived after thawing,the recovery rate was95.43%（167/175）,in which 69 transplantable blastocysts were formed in 40 cycles and used for transfer,but 9 cycles were cancelled due to no blastocyst formation,the blastocyst formation rate was 41.32%（69/167）,the implantation rate was 31.88%（22/69）,18 clinical pregnancy cycles were obtained,the pregnancy rate was 45.00%（18/40） and the early abortion rate was11.11%（2/18）.The blastocyst recovery rate of the group A was significantly lower than the D3 cleavage stage embryo recovery rate of the group B（P〈0.05）.There were no differences in implamtation rate, clinical pregnancy rate,early abortion rate and ectopic pregnancy rate between the two groups（P〈0.05）. Conclusion The blastocyst may be the preferable stage for vitrifying and freezing embryo,the vitrified frozen blastocyst implantation after unfreezing can get higher pregnancy rate,but the blastocyst implantation by in vitro sequential culture after D3 cleavage embryo freeze-thawing needs to be carefully carried out by closely combining with the clinical actual situation.