全囊胚培养在高龄低储备不孕患者中的应用分析

Application Analysis of All-blastocyst-culture in Elderly Infertile Patients with Low Ovarian Reserve

【目的】探讨全囊胚培养是否能使高龄低储备不孕患者获益。【方法】回顾性分析2016年5月至2017年4月于中山大学附属第六医院生殖医学研究中心就诊,采用IVF/ICSI助孕的高龄低储备不孕患者。根据第3天(D3)可移植胚胎的处理方式分为全养囊胚组(A组)及不养囊胚组(B组),比较两组的累积生化妊娠率,累积临床妊娠率。【结果】一共纳入符合条件的231名患者进行统计,A组130名,B组101名。两组患者的基本情况无差异。A组的累积生化妊娠率/临床妊娠率高于B组,差异无统计学意义(P>0.05)。剔除A组中因无囊胚形成而最终未行胚胎移植的患者后,A组的累积生化妊娠率/临床妊娠率显著优于B组(P<0.05)。对患者基本情况与培养囊胚结局的多因素分析结果显示:D3可移植胚胎数少是培养囊胚失败的危险因素(OR=0.277,95%CI为0.103~0.744,P<0.05)。【结论】高龄低储备不孕患者行全囊胚培养不会对妊娠结局造成不利影响。相反,只要培养成囊胚可供移植,囊胚培养组的妊娠结局优于不养囊胚组;D3可移植胚胎数量少是培养囊胚失败的危险因素。在对患者进行充分地知情告知后,我们可酌情考虑对部分高龄低储备不孕患者行全囊胚培养。

【Objective】To determine whether all-blastocyst-culture can benefit elderly infertile patients with low ovarian reserve.【Methods】To retrospectively analyze elderly patients with low ovarian reserve undergoing IVF/ICSI in Reproductive Medicine Re-search Center of the Sixth Affiliated Hospital of Sun Yat-sen University from May 2016 to April 2017.We divide them into group A(All-blastocyst-culture)and group B(None-blastocyst-culture)based on different culture approach of D3 transferrable embryo. Tocompare the cumulative biochemical pregnancy rate,cumulative clinical pregnancy rate between them.【Results】A total of 231 eligi-ble patients are included,with130 in group A and 101 in group B. The basic conditions of the two groups show no difference. Cumula-tive biochemical pregnancy rate/clinical pregnancy rate in group A is higher than that of group B,though the difference is not statisti-cally significant(P>0.05). After removing patients who did not undergo embryo transfer due to failure in blastocyst culture,the cumu-lative biochemical pregnancy rate/clinical pregnancy rate in group A is significantly higher than group B(P<0.05). Multivariate analy-sis of the patient′s basic condition and the outcome of blastocyst culture showed that the number of D3 transferrable embryo was a riskfactor for the failure of blastocyst culture(OR=0.277,95%CI:0.103 ~ 0.744,P<0.05).【Conclusion】All-blastocyst-culture will notadversely affect the pregnancy outcome of elderly infertile patients with low ovarian reserve. On the contrary,once they obtain transfer-rable embryos, pregnancy outcome in All-Blastocyst-Culture group are better than None-Blastocyst-Culture group. A small number ofD3 transferrable embryo is a risk factor for failure to culture blastocyst. If the patients were fully informed consent,we can considerimplementing all-blastocyst-culture for elderly infertile patients with low ovarian reserve.