不同囊胚发育期对囊胚解冻移植周期临床结局的影响

Effect of blastocyst at different developmental stages on the clinical outcomes of human blastocyst frozen-thaw cycles

目的比较不同发育期别的囊胚对冷冻复苏的耐受程度及解冻移植的临床结局。方法回顾性分析2012年1月至2013年12月北京大学第三医院生殖医学中心行囊胚冷冻与复苏移植的不孕症患者的临床资料,排除行植入前遗传学诊断、睾丸/附睾精子抽吸术及关键数据缺失的周期。分析解冻存活率与损伤率、着床率、宫内活胎率、临床妊娠率、活产率和新生儿出生结局等指标。结果 3、4、5、6期囊胚解冻后存活率比较差异无统计学意义(P>0.05),但3期囊胚解冻后损伤率最高,着床率和宫内活胎率最低(P <0.05);6期囊胚组的着床率和宫内活胎率最高(P <0.05),但解冻损伤率也较高;5期囊胚组着床率和宫内活胎率分别为45.57%(36/79)、39.24%(31/79),虽然略低于6期囊胚组,但差异均无统计学意义(P>0.05),且5期囊胚组出生婴儿体质量高于6期囊胚组(P <0.05)。结论 5期及以上分期是玻璃化冷冻保存囊胚的最佳时期。

Objective To analyze thecryodamage tolerance of blastocysts at different developmental stages and their clinical outcomes. Methods A retrospective study was conducted to analyze the clinical data of infertile patients who underwent frozen-thawed blastocyst transplantation at Peking University Third Hospital’s Reproductive Center from January 2012 to December 2013. This study excluded the cycles undergoing preimplantation genetic diagnosis, testicular/epididymal sperm aspiration, and cases those lacked key data. The survival rate, injury rate, implantation rate, intrauterine live birth rate, clinical pregnancy rate, live birth rate and neonatal outcome were analyzed. Results There was no statistically difference in the survival rates of blastocysts at stages 3, 4, 5, and 6 after thawing. However, the cryodamage rate of stage 3 blastocysts was the highest, while the implantation rate and intrauterine live birth were the lowest(P < 0.05). The implantation rate and intrauterine live birth of stage 6 blastocyst group were the highest(P < 0.05), but their cryodamage rate was a little high;The implantation rate and intrauterine live birth of stage 5 blastocyst group were 45.57%(36/79) and 39.24%(31/79), respectively, which were slightly lower than those of stage 6 blastocyst group, but the difference was not statistically significant(P > 0.05), and the birth weight of infants in stage 5 blastocyst group was higher than that in stage 6 blastocyst group(P < 0.05). Conclusion Blastocysts at stage 5 may be the best stage for blastocysts cryopreservation.