冷冻胚胎复苏后发育情况与妊娠结局的关系

Relationship between pregnancy outcome and proliferation of embryo blastomere after frozen embryo thawed

目的观察冷冻胚胎复苏并过夜培养后的卵裂球增殖情况与临床妊娠结局的关系。方法回顾性分析2015年1月—2016年12月在同济大学附属同济医院生殖医学中心行冷冻胚胎复苏培养后移植的周期991例,按照复苏胚胎过夜培养后卵裂球增殖与否及增殖比例进行研究。依据移植的2枚胚胎是否增殖分为2枚增殖(S2)、1枚增殖(S1)及2枚均未增殖(S0)三组;在S2中,再根据卵裂球增殖比率分为a:增殖形成桑葚胚或早期囊胚;b:卵裂球增殖率≥50%;c:50%>卵裂球增殖率≥25%;d:卵裂球增殖率<25%,进一步分为A(aa、ab、ac、ad)、B(bb、bc、bd)和C(cc、cd、dd)三个区段共10组,统计各组临床妊娠率、流产率等指标。结果 S2、S1、S0三组临床妊娠率分别为46.41%、23.08%及12%,差异有统计学意义(P<0.05);A、B、C各区段的临床妊娠率分别为59.77%、47.43%及24.43%,差异有统计学意义(P<0.05);在各区段中,随着其中一枚胚胎的增殖比率下降,妊娠率均有不同程度降低。结论冷冻胚胎复苏后过夜培养,选择移植进一步发育的胚胎具有更好的妊娠结局。

Objective To investigate the relationship between pregnancy outcome and the proliferation of embryo blastomere after frozen embryo thawed.Methods A retrospective study including 991 frozen-thawed embryo transfer(FET)cycles during January 2015 to December 2016 was performed.In each cycle,2 thawed embryo blastomeres were cultured overnight and the proliferation of blastomere was observed and divided into three groups:group S2(proliferation in 2 embryos),group S1(proliferation in 1 embryo)and group S0(no proliferation was two embryos).The state of blastomere proliferation in group S2 were defined as:a(proliferates to morula or early blastula),b(proliferation rate≥50%),c(proliferation rate≥25%and<50%)and d(proliferation rate<25%),then group S2 was further sub-grouped as A(aa,ab,ac,ad),B(bb,bc,bd)and C(cc,cd,dd)according the proliferation status of 2 embryos.The pregnancy rate and abortion rate in each groups or subgroups were analyzed.Results The clinical pregnancy rate of groupsS2,S1,S0 was 46.41%,23.08%,12%,respectively(P<0.01).The clinical pregnancy rate of subgroups A,B and C in group S2 was 59.77%,47.43%and 24.43%,respectively(P<0.05).Conclusion Selection of the cryopreserved embryos with further cleavage after frozen-thawed may increase the pregnancy rate in IVF-ET.