卵裂期无可移植胚胎患者行囊胚培养后早期囊胚的最佳移植策略

Optimal Transfer Strategy for Early blastocysts in Patients without Transferable Cleavage-Stage Embryos

【目的】分析卵裂期无可移植胚胎的患者,在第5天新鲜移植Gardner Ⅰ期,Ⅱ期囊胚的临床结局,探讨最佳的移植策略。【方法】回顾性分析2014年1月至2019年12月本中心行IVF治疗,卵裂期无可移植胚胎行囊胚培养并且单囊胚移植的患者,其中Ⅰ期囊胚移植组97个周期,Ⅱ期囊胚移植组81个周期,对照组为第3天为2级胚胎的卵裂胚新鲜移植组754个周期(对照组1),卵裂期无可移植胚胎的第6天冷冻囊胚FET周期144例(对照组2)。研究组和对照组均为单囊胚/单胚胎移植周期。分析各组的临床结局及新生儿情况,包括活产率,临床妊娠率,早期流产率,继续妊娠率,新生儿出生孕周,体质量,身长。【结果】与对照组1相比,新鲜周期第5天的Ⅰ期囊胚移植组活产率(7.22%vs. 18.83%),临床妊娠率(11.34%vs. 25.33%)和继续妊娠率(7.22%vs. 19.89%)均显著下降(P<0.01),早期流产率和新生儿情况(出生孕周、身高、体质量)两组差异无统计学意义(P>0.05)。Ⅱ期囊胚移植组与对照组1相比,临床结局以及新生儿情况比较,差异均无统计学意义(P>0.05)。与对照组2相比,新鲜周期第5天的Ⅰ期囊胚移植组活产率(7.22%vs. 15.97%),临床妊娠率(11.34%vs. 24.31%)和继续妊娠率(7.22%vs. 15.97%)均显著下降(P<0.05),早期流产率和新生儿情况(出生孕周、身高、体质量)两组差异无统计学意义(P>0.05)。Ⅱ期囊胚移植组与对照组2相比,临床结局以及新生儿情况比较,差异均无统计学意义(P>0.05)。【结论】对于卵裂期不可移植胚胎行囊胚培养,第5天的I期囊胚继续延长培养后FET移植,Ⅱ期囊胚新鲜移植,可获得较高的临床妊娠率和活产率。

【Objective】To analyze the clinical outcomes of Gardner stage Ⅰ and stage Ⅱ fresh blastocysts transfer on day 5 in patients without transferable cleavage-stage embryos,so as to explore the best transfer strategy.【Methods】A retrospective analysis was done on patients without transferable cleavage-stage embryos who underwent single blastocyst transfer in our IVF center from January 2014 to December 2019. Of the total of 178 cycles of fresh blastocyst transfer,97 involved stage Ⅰ and 81 stage Ⅱ. Control Group 1 included 754 cycles of fresh grade 2 cleavage-stage embryo transfer on day3 and Control Group 2 included 144 transfer of day-6 vitrified blastocysts. Like study groups,two control groups were also single blastocyst or single embryo transfer cycles. The clinical outcomes including live birth rate,clinical pregnancy rate,early miscarriage rate and ongoing pregnancy rate,and neonatal conditions such as gestational week at delivery,neonatal weight and length were analyzed among the groups.【Results】The live birth rate(7.22% vs. 18.83%/7.22% vs. 15.97%),clinical pregnancy rate(11.34% vs. 25.33%/11.34% vs. 24.31%)and ongoing pregnancy rate(7.22% vs. 19.89%/7.22%vs. 15.97%)were significantly decreased in fresh stage I blastocyst transfer group than those in Control Group 1(P < 0.01)and Control Group 2(P < 0.05). There was no significant difference in early miscarriage rate and neonatal conditions between fresh stage I blastocyst transfer group and Control Group 1 or between fresh stage I blastocyst transfer group and Control Group 2(all P > 0.05). There was no significant difference in clinical outcomes and neonatal conditions between fresh stage Ⅱ blastocyst transfer group and Control Group 1 or between fresh stage Ⅱ blastocyst transfer group and Control Group 2(all P > 0.05).【Conclusion】In patients without transferable cleavage-stage embryos,all embryos are better to be cultured to blastocyte-stage. Higher clinical pregnancy rate and live birth rate could be achieved if stage I blastocysts on D5 is transferred in a subsequent thawed-cycles after extended culture and stage Ⅱ blastocysts on D5 is transferred in fresh cycles.