培养时间长短对卵裂期胚胎解冻后妊娠结局的影响

Effect of culture time on the outcome of pregnancy after thawing cleavage stage embryos

目的探讨培养时间长短对卵裂期胚胎解冻后妊娠结局的影响。方法回顾性分析2015年1月~2017年7月我中心562个卵裂期FET周期,根据解冻时间分为提前半天(前一天下午)解冻组(A组,n=478),当天解冻组(B组,n=84);又将A组按卵裂球增殖与否分为A1组(n=321)均增殖,A2组(n=131)部分增殖,A3组(n=26)不增殖;同时根据卵裂球增殖数目将有增殖胚胎周期(包括均增殖和部分增殖)分为Aa组(n=184)至少有一个融合胚胎,Ab组(n=268)无融合胚胎,比较各组间的移植结局。结果 A组与B组临床妊娠率、种植率和多胎率分别为47.28﹪、51.19﹪;28.29﹪、30.68﹪;26.99﹪、25.58﹪,差异均无统计学意义(P>0.05);A1组临床妊娠率、种植率(分别为50.47﹪、30.92﹪)均高于A2组(分别为38.93﹪、20.90﹪),差异有统计学意义(P<0.05),两组多胎率无明显差异(P>0.05)。A1组与A3组妊娠结局无差异。A3组种植率及多胎率均高于A2组(分别为34.55﹪vs 20.90﹪,46.15﹪vs 17.65﹪,P<0.05);Aa组临床妊娠率、种植率(分别为59.78﹪、37.95﹪)极显著高于Ab组(分别为38.43﹪、21.12﹪,P=0.00),而多胎率亦同时显著高于Ab组(33.64﹪vs 17.48﹪,P<0.01)。结论冻融移植中卵裂期胚胎解冻后培养时间不影响其妊娠结局,实验室可根据工作需要合理安排解冻时间。解冻后过夜培养观察卵裂球全部增殖的周期尤其存在一个以上融合胚胎的周期有更好的妊娠结局,但同时需注意控制多胎率,可根据实际情况行单胚胎移植。

Objective To investigate the effect of culture time on the outcome of pregnancy after thawing cleavage stage embryo. Methods A retrospective study was carried out in 562 frozen-thawed embryo transfer（FET） cycles in our center from Jan 2015 to Jul 2017. The embryos were transferred either on the same day after thawing（group B）or half a day ahead（group A） before thawing.According to whether or not blastomere proliferation during the post-thawed culture,group A was subdivided into 3 groups ：group A1 with all embryos proliferation（n=321）;group A2 with some of embryos proliferation（n=131）;group A3 with none of the embryo proliferation（n=26）.At the same time the cycles were divided into two groups according to amount of blastomere proliferation ：at least one compact embryo was found in group Aa（n=184）, and no compact embryo was found in group Ab（n=268）.Implantation outcomes of these groups were compared. Results The clinical pregnancy rate（47.28﹪ vs 51.19﹪）,implantation rate（28.29﹪ vs 30.68﹪） and multiple pregnancy rate（26.99﹪ vs 25.58﹪） were not statistically significant difference between group A and group B（P〈0.05）. The clinical pregnancy rate（50.47﹪）,implantation rate（30.92﹪） of group A1 were higher than that of group A2（38.93﹪,20.90﹪）,P〈0.05,but both of them had no significantly difference in multiple pregnancy rate. There was no significant difference on pregnancy outcome between group A1 and group A3. The implantation rate and multiple pregnancy rate of group A3 were higher than that of group A2（P〈0.05）. The pregnancy rate,implantation rate and multiple pregnancy rate in group Aa were significantly higher than that in group Ab（P=0.00,P〈0.01）. Conclusion The culture time after frozen-thawed embryos does not affect the pregnancy outcome, and the laboratory can arrange the thawing time reasonably according to job demand. Frozen-thawed embryos at cleavage stage after overnight cluture,which embryos all grown and especially blasomeres developed to compaction formed,can obtain better clinical outcomes. Single embryo transfer can be considered for these cycles.