冻融卵裂期优质胚胎发育速度对临床妊娠结局的影响

Effect of development rate of high-quality frozen-thawed embryos at cleavage stage on clinical pregnancy outcome

目的探讨冻融卵裂期优质胚胎过夜培养后卵裂球数目翻倍增长情况与冻融胚胎移植(FET)周期临床妊娠结局的关系。方法回顾性分析2016年1月至2020年1月在本中心因新鲜周期未移植及新鲜周期移植妊娠失败行FET的1723个周期的临床资料。根据移植胚胎数目不同分为A组(移植1枚胚胎,n=183)和B组(移植2枚胚胎,n=1540);根据冻融胚胎过夜培养后卵裂球数目是否达到翻倍或以上,分为倍增组(n=843)和未倍增组(n=361);按照卵裂球数目是否倍增将A组细分为A1组(倍增组,n=108)和A0组(未倍增组,n=75),B组细分为B2组(2枚胚胎均倍增组,n=735)、B1组(仅1枚胚胎倍增组,n=519)和B0组(2枚胚胎均未倍增组,n=286)。比较各组的一般资料及临床妊娠结局。结果纳入的1723个周期中,临床妊娠周期数为1041个,妊娠率60.4%;B组胚胎种植率及临床妊娠率均显著高于A组(P<0.05)。倍增组(A1组+B2组)胚胎种植率、临床妊娠率和活产率均显著高于未倍增组(A0组+B0组)(P<0.05),两组流产率、早产率无显著性差异(P>0.05);A1组临床妊娠率、活产率、早产率均显著高于A0组(P<0.05),两组流产率无显著性差异(P>0.05);B2组、B1组、B0组3组种植率、临床妊娠率、活产率均有显著性差异(P均<0.05),B2组宫内多胎妊娠率显著高于其他两组(P<0.05),而3组流产率、晚期流产率、早产率均无显著性差异(P均>0.05)。结论冻融卵裂期优质胚胎过夜培养后卵裂球数目发生翻倍增长,提示能获得更好的临床妊娠结局。复苏2枚冻融优质胚胎过夜培养后卵裂球数目均翻倍增长的情况下,可以考虑单胚胎移植,从而减少多胎妊娠风险。

Objective:To explore the relationship between the doubling of blastomere number after overnight culture of high-quality frozen-thawed embryos at cleavage stage and clinical pregnancy outcome of frozen-thawed embryo transfer(FET).Methods:The data of 1723 FET cycles in our department were analyzed retrospectively.The number of non-destructive high-quality frozen-thawed embryos transferred were 1 or 2.According to the number of embryos transferred,the cycles were divided into group A(1 embryo transfer,n=183)and group B(2 embryos transfer,n=1540).The cycles were divided into two groups according to whether the number of blastomeres doubled or more after overnight culture:doubling group(n=843)and non-doubling group(n=361).According to whether the number of blastomeres doubled,group A was subdivided into A1 group(doubling group,n=108)and A0 group(non-doubling group,n=75);group B was divided into B2 group(2 doubling embryos group,n=735),B1 group(1 doubling embryo group,n=519)and B0 group(2 non-doubling embryos group,n=286).The general information and clinical pregnancy outcome of each group were compared.Results:The implantation rate,clinical pregnancy rate and live birth rate in the doubling group(A1+B2)were significantly higher than those in the non-doubling group(A0+B0)(P<0.05),but the abortion rate and premature birth rate were not significantly different between the two groups(P>0.05).The clinical pregnancy rate,live birth rate and premature birth rate in group A1 were significantly higher than those in group A0(P<0.05),but the abortion rate was not significantly different(P>0.05).There were significant differences in implantation rate,clinical pregnancy rate and live birth rate among groups B2,B1 and B0(P<0.05).The rate of intrauterine multiple pregnancy in group B2 was significantly higher than that in group B1 and group B0(P<0.05).There were no significant differences in the abortion rate,late abortion rate and premature birth rate among the three groups(P>0.05).Conclusions:The doubled number of blastomeres of high-quality frozen-thawed embryos at cleavage stage after overnight culture,suggests a better clinical pregnancy outcome can be obtained.After overnight culture,if the number of blastomeres of two thawed embryos doubled,single embryo transfer can be considered to reduce the risk of multiple pregnancy.