第5日与第6日高质量冻融囊胚移植临床结局的比较研究

Comparative study of the clinical outcomes of the day 5 and day 6 high-quality frozen-thawed blastocyst transplantation

目的比较研究冻融囊胚移植(frozen-thawed blastocyst transfer,FBT)周期移植第5日(D5)与第6日(D6)高质量囊胚的临床结局差异。方法回顾性分析2013年1月—2017年8月期间在本中心接受FBT的365例共387个周期不孕症患者的临床结局,根据形成扩张囊胚的天数及移植胚胎的个数分4组,分别为第5日双囊胚移植组(double D5 blastocysts transfer group,DET5组)88个周期、第5日单囊胚移植组(single D5 blastocyst transfer group,SET5组)69个周期、第6日双囊胚移植组(double D6 blastocysts transfer group,DET6组)129个周期及第6日单囊胚移植组(single D6 blastocyst transfer group,SET6组)101个周期。结果四组患者的平均年龄、不孕年限、内膜厚度、基础卵泡刺激素(FSH)及冻融胚胎的复苏率比较,组间差异无统计学意义(P>0.05);SET5组的临床妊娠率(62.3%)和种植率(62.3%)显著高于SET6组(46.5%,46.5%)(P均为0.04),与DET5组和DET6组比较差异无统计学意义(P>0.05);DET5组及DET6组的多胎率均为42.6%,分别与SET5组及SET6组(均为0.0%)比较,差异有统计学意义(P均为0.00)。结论 FBT周期选择高质量的D5囊胚进行单胚胎移植,可以确保临床妊娠率和种植率,并显著降低多胎率。

Objective To compare the differences of clinical outcomes in frozen-thawed blastocyst transfer （FBT） cycles between high-quality blastocysts on day 5 （D5） and on day 6 （D6）. Methods Retrospective analysis of clinical outcomes was performed on 365 infertility patients with 387 FET cycles from January 2013 to August 2017. It was divided into four groups according to the days of the expanded blastocyst formation and the numbers of embryo transfer, there were respectively 88 cycles in double D5 blastocysts transfer group （DET5） group, 69 cycles in single D5 blastocyst transfer group （SET5） group, 129 cycles in double D6 blastocysts transfer group （DET6） group and 101 cycles in single D6 blastocyst transfer group （SET6） group. Results There was no significant difference in the age of patients, the infertile duration, the endometrium thickness and the proportion of embryos that survived the thawing process （P〉0.05）. The pregnancy rate （62.3%） and the implantation rate （62.3%） of SET5 group were significantly higher than those of SET6 group （46.5%, 46.5%） （P=0.04, P=0.04）, but there was no significant difference with DET5 group and DET6 group （P〉0.05）. The multiple pregnancy rate of DET5 group （42.6%） and DET6 group （42.6%） was significantly higher than that of SET5 group （0.0%） and SET6 group （0.0%） （P=0.00, P=0.00）. Conclusion In FBT cycles, selecting D5 high-quality blastocyst for SET can ensure the clinical pregnancy rate and implantation rate, and significantly reduce the multiple pregnancy rate.