囊胚整体质量对冻融单囊胚移植妊娠和新生儿结局的影响

Influence of overall blastocyst quality on pregnancy and neonate outcome after single frozen blastocyst transfer

目的探讨囊胚整体质量对冻融单囊胚移植临床结局及新生儿结局的影响。方法回顾性分析2016~2017年本生殖中心行冻融单囊胚移植(FET)的984例患者资料,根据囊胚质量分成3组:A组为高质量囊胚(n=259);B组为中等质量囊胚(n=400);C组为低质量囊胚(n=325)。同时根据滋养层外是否存在碎片或卵裂球对C组患者进一步分组:C1组为不存在碎片或卵裂球(n=197);C2组为存在碎片或卵裂球(n=128)。对临床妊娠率、流产率、活产率、新生儿出生体重进行比较。结果A、B、C三组患者的临床妊娠率(70.66%vs.60.75%vs.44.31%,P<0.05)及活产率(61.39%vs.48.00%vs.34.46%,P<0.05)两两比较均有显著性差异;A、B、C三组患者的流产率逐渐增加,但无显著性差异(13.11%vs.19.75%vs.22.92%,P>0.05);A、B、C三组患者的新生儿出生体重无显著性差异(P>0.05)。C2组的临床妊娠率(50.00%vs.40.61%,P<0.05)及活产率(39.84%vs.30.96%,P<0.05)均显著高于C1组。结论囊胚整体质量显著影响临床妊娠率,活产率;对于低质量囊胚,滋养层外碎片或卵裂球不应作为临床妊娠率和活产率的负性指标。

Objective:To evaluate the influence of overall blastocyst quality on clinical and neonate outcome of single frozen-thawed blastocyst transfer.Methods:The data of 984 single frozen-thawed blastocyst transfer cycles in our hospital from 2016 to 2017 were retrospectively analyzed.According to the overall blastocyst quality,the cycles were divided into three groups:group A:high quality blastocyst(n=259),group B:medium quality blastocyst(n=400),group C:low quality blastocyst(n=325).Meanwhile,according to whether there were extratrophoblastic fragments or blastomeres,the cycles in group C were divided into two subgroups:group C1:without fragments or blastomeres(n=197),group C2:with fragments or blastomeres(n=128).Clinical pregnancy rate,abortion rate,live birth rate and neonatal birth weight were compared.Results:There were significant differences in the clinical pregnancy rate(70.66%vs.60.75%vs.44.31%,P<0.05)and live birth rate(61.39%vs.48.00%vs.34.46%,P<0.05)among the three groups.The abortion rate of group A,B and C increased gradually,but there was no significant difference(13.11%vs.19.75%vs.22.92%,P>0.05).There was no significant difference in neonatal birth weight among groups A,B and C(P>0.05).The clinical pregnancy rate(50.00%vs.40.61%)and live birth rate(39.84%vs.30.96%)of group C2 were significant higher than that of group C1(P<0.05).Conclusions:The overall quality of blastocyst affects clinical pregnancy rate and live birth rate.In the case of low quality blastocysts,the extratrophoblastic fragments or blastocysts should not be used as negative indicators of clinical pregnancy rate and live birth rate.