CC级单囊胚冻融移植周期临床结局分析

Clinical outcome of grade-CC single blastocyst transfer in frozen-thawed cycle

目的探讨冻融胚胎移植(FET)周期中CC级单囊胚移植的应用价值。方法回顾性分析2017年1月至2019年12月在本院生殖中心行单囊胚FET的645个周期,对CC级(CC组,142周期)和非CC级(非CC组,503周期)单囊胚FET结局进行比较,同时分析不同年龄段(≤35岁、36~40岁、>40岁)CC级和非CC级囊胚的妊娠结局,并比较分析了CC级囊胚形成时间(D5、D6、D7)以及患者年龄(≤35岁、36~40岁、>40岁)对于FET结局的影响。结果(1)共纳入645个单囊胚FET周期,临床妊娠率为46.20%,活产率为35.81%。其中142个CC级单囊胚FET周期临床妊娠率26.76%、活产率18.31%,均显著低于非CC级单囊胚FET周期(分别为52.69%、40.76%)(P<0.05),但两组间的早期流产率、早产率和新生儿出生体重均无统计学差异(P>0.05)。(2)患者年龄≤35岁和36~40岁时,CC组的临床妊娠率(分别为36.36%、25.58%)和活产率(分别为25.76%、18.60%)均显著低于非CC组的临床妊娠率(分别为59.75%、44.78%)和活产率(分别为47.48%、35.07%)(P<0.05);患者年龄>40岁时,CC组与非CC组的临床妊娠率(9.09%vs.19.61%)和活产率(3.03%vs.11.76%)无统计学差异(P>0.05)。(3)CC级单囊胚FET周期D5、D6、D7亚组临床妊娠率(分别为41.94%、25.27%、10.00%)及活产率(分别为29.03%、17.58%、5.00%)比较,D5亚组临床妊娠率显著高于D7亚组(P<0.05)。(4)CC级单囊胚FET周期在≤35岁、36~40岁、>40岁年龄亚组的临床妊娠率(分别为36.36%、25.58%、9.09%)及活产率(分别为25.76%、18.60%、3.03%)比较,≤35岁亚组临床妊娠率显著高于>40岁亚组,≤35岁、36~40岁亚组活产率显著高于>40岁亚组(P<0.05)。结论CC级单囊胚FET周期临床妊娠率和活产率虽低于非CC级囊胚,但依然有一定的活产率;CC级单囊胚FET临床妊娠率及活产率与囊胚形成时间、患者年龄有关;对于反复胚胎质量差没有优质囊胚的患者,可根据患者年龄、囊胚形成时间考虑CC级囊胚移植。

Objective:To explore the value of grade-CC single blastocyst transfer in frozen-thawed embryo transfer(FET)cycle.Methods:The data of 645 cycles of single blastocyst FETs from January 2017 to December 2019 were retrospectively analyzed.The results of grade-CC(142 cycles)and non-grade-CC(503 cycles)were compared.The pregnancy outcomes of grade-CC and non-grade-CC blastocysts in different age groups(≤35 years,36-40 years,and>40 years)were analyzed.In addition,the effects of grade-CC blastocyst formation time(Day 5,Day 6,Day 7)and patient age(≤35 years,36-40 years,>40 years)on FET outcome were compared and analyzed.Results:(1)There were 645 single blastocyst FET cycles.The clinical pregnancy rate was 46.20%and the live birth rate was 35.81%.The clinical pregnancy rate(26.76%vs.52.69%)and the live birth rate(18.31%vs.40.76%)were significantly lower than those of non-grade-CC(P<0.05).There was no significant difference in the early abortion rate,premature delivery rate and newborn weight between the two groups(P>0.05).(2)When the age of patients was≤35 years and 36-40 years,the clinical pregnancy rate(36.36%,25.58%)and live birth rate(25.76%,18.60%)in grade-CC group were significantly lower than those in non-grade-CC group(59.75%,44.78%;47.48%,35.07%,respectively)(P<0.05).When the age of patients was more than 40 years old,there was no significant difference in the clinical pregnancy rate(9.09%vs.19.61%)and live birth rate(3.03%vs.11.76%)between the grade-CC group and the non-grade-CC group(P>0.05).(3)Comparison of the clinical pregnancy rate(41.94%,25.27%,10.00%)and live birth rate(29.03%,17.58%,5.00%)in Day 5,Day 6,Day 7 subgroups of grade-CC single blastocyst of FET cycle,the clinical pregnancy rate of Day 5 subgroup was significantly higher than that in Day 7 subgroup(P<0.05).(4)Comparison of the clinical pregnancy rate(36.36%,25.58%,9.09%)and live birth rate(25.76%,18.60%,3.03%)of grade-CC single blastocyst FET cycles in three age subgroups,the clinical pregnancy rate in≤35 years subgroup was significantly higher than that in>40 years subgroup,and the live birth rate in≤35 years subgroup and 36-40 years subgroup were significantly higher than that in>40 years subgroup(P<0.05).Conclusions:Although the clinical pregnancy rate and live birth rate of grade-CC blastocysts FET are lower than those of non-grade-CC blastocysts,there is still a certain live birth rate.The clinical pregnancy rate and live birth rate of grade-CC blastocysts are related to the time of blastocyst formation and the age of patients.For patients with recurrent poor-quality embryos and no good-quality blastocysts,grade-CC blastocyst transfer can be considered to transfer according to the age of patients and blastocyst formation time.