形态学评分相近的单囊胚复苏移植选择策略

Selection strategy of single blastocyst resuscitation transfer with similar morphological score

目的探讨在形态学评分相似的情况下,比较复苏周期单囊胚移植中内细胞团与滋养层细胞的评分对妊娠结局的影响。方法回顾性分析2014年1月~2020年1月在本院生殖医学中心完成的810个复苏的单个四期囊胚移植周期。根据囊胚形态学评分分为四组:4AB、4BA、4BC和4CB。比较形态学评分相似的两组单囊胚移植患者的临床资料,分析内细胞团与滋养层细胞的形态学评分对妊娠结局的影响。结果4AB与4BA囊胚组比较,临床妊娠率(66.7%vs 66.1%)、生化妊娠率(4.2%vs 5.1%)和早期自然流产率(11.5%vs 10.8%)均无统计学差异。4CB囊胚组的临床妊娠率显著高于4BC组(51.4%vs 39.7%),而生化妊娠率(14.1%vs 11.7%)和早期自然流产率(18.2%vs 18.9%)均无统计学差异。优质囊胚组(4AB和4BA)的妊娠结局显著优于非优质囊胚组(4BC和4CB)(P均<0.05)。结论复苏周期单囊胚移植中,对于优质的四期囊胚,内细胞团和滋养层细胞的形态学评分差异对于妊娠结局无显著影响,均可选择用于复苏周期移植;而对于非优质的四期囊胚,选择更高评分滋养层细胞的囊胚有助于提高临床妊娠率。总体而言,优质四期囊胚的妊娠结局优于非优质四期囊胚。

Objective To explore the effect of the scores of inner cell mass and trophoblast cells on the outcome of pregnancy in single blastocyst resuscitation transfer cycles under similar morphological scores.Methods 810 single resuscitation four-stage blastocyst transfer cycles completed in the Reproductive Medicine Center of our hospital from January 2014 to January 2020 were retrospectively analyzed.According to the blastocyst morphology score,they were divided into four groups:4 AB,4 BA,4 BC and 4 CB.The clinical data of two groups of patients with single blastocyst transfer with similar morphological scores were compared,and the effect of morphological scores of inner cell mass and trophoblast cells on pregnancy outcome was analyzed.Results There was no significant difference in clinical pregnancy rate(66.7%vs 66.1%),biochemical pregnancy rate(4.2%vs 5.1%)and early spontaneous abortion rate(11.5%vs 10.8%)between 4 AB and 4 BA groups.The clinical pregnancy rate in the 4 CB blastocyst group was significantly higher than that in the 4 BC group(51.4%vs 39.7%),while there was no significant difference between the biochemical pregnancy rate(14.1%vs 11.7%)and early spontaneous abortion rate(18.2%vs 18.9%).The pregnancy outcome of the high-quality blastocyst groups(4 AB and 4 BA)was significantly better than that of the non-high-quality blastocyst groups(4 BC and 4 CB)(P<0.05 for both).Conclusion In single blastocyst transfer resuscitation cycles,for high-quality four-stage blastocysts,there is no difference in morphological scores of the inner cell mass and trophoblast cells on pregnancy outcomes,and they can be selected for resuscitation cycle transfer.In the non-high-quality four-stage blastocyst,selecting a blastocyst with a higher score of trophoblast cells can help improve the clinical pregnancy rate.Overall,the pregnancy outcome of highquality fourth-stage blastocysts is better than that of non-high-quality fourth-stage blastocysts.