D3胚胎形态学评分对单囊胚冻融移植周期临床结局的影响

Effect of morphological score of Day 3 embryo on clinical outcome of single blastocyst frozen-thawed transfer cycle

目的探讨D3胚胎形态学评分对单囊胚冻融移植周期临床结局的影响。方法回顾性分析2017年4月至2020年1月在本生殖中心行单囊胚冻融移植的699个周期的临床资料。根据囊胚来源的D3胚胎形态学评分分为两组:D3非优质胚胎(D3非优胚组,n=492),D3优质胚胎(D3优胚组,n=207);同时,根据不同囊胚形成时间分为3个亚组:D5囊胚组、D6囊胚组和D7囊胚组;又根据患者年龄不同分为3个年龄段:<35岁、35~39岁和≥40岁。比较各组单囊胚冻融移植周期的临床结局。结果D3优胚组来源囊胚的优质囊胚率、临床妊娠率和活产率(分别为45.41%、53.62%和42.03%)均显著高于D3非优胚组来源囊胚(分别为25.81%、44.11%和33.13%)(P<0.05);D5囊胚组的HCG阳性率、临床妊娠率和活产率(分别为68.58%、57.92%和44.81%)显著高于D6囊胚组(分别为51.66%、38.69%和28.83%)和D7囊胚组(分别为32.26%、32.26%和22.58%)(P<0.05),在D5囊胚组、D6囊胚组和D7囊胚组中D3优胚组来源囊胚的活产率均高于D3非优胚组来源囊胚[分别为(44.44%vs.39.53%)、(36.84%vs.27.10%)、(33.33%vs.20.00%)],但均无显著差异(P>0.05);在不同年龄亚组中,<35岁组和35~39岁组的活产率均显著高于≥40岁组(43.89%、34.25%vs.14.17%,P<0.05),但在相同年龄亚组中,D3优胚组和D3非优胚组来源的囊胚移植活产率比较均无显著差异(P>0.05)。结论评分低的D3胚胎延长培养至囊胚后再移植仍可获得一定的活产率;无论D3优胚或非优胚来源的D7囊胚移植后仍有一定的活产率。

Objective:To investigate the effect of morphological score of Day 3 embryo on clinical outcome of single blastocyst frozen-thawed transfer cycle.Methods:The clinical data of 699 single blastocyst transfer cycles in our reproductive center from April 2017 to January 2020 were retrospectively analyzed.These cycles were divided into two groups by the morphological score of Day 3 embryo:Day 3 non-good quality embryo group(n=492)and Day 3 good quality embryo group(n=207).Meanwhile,the cycles were divided into three subgroups according to different blastocyst formation time:Day 5,Day 6 and Day 7 groups.Lastly,the cycles were divided into three subgroups by the patient’s age:<35 years old group,35-39 years old group and≥40 years old group.The pregnancy outcomes were compared among the groups.Results:The good quality blastocyst rate(45.41%vs.25.81%),clinical pregnancy rate(53.62%vs.44.11%)and live birth rate(42.03%vs.33.13%)of blastocysts derived from Day 3 good quality embryo group were significantly higher than those from Day 3 non-good quality embryo group(P<0.05).The HCG positive rate,clinical pregnancy rate and live birth rate in Day 5 blastocyst group(68.58%,57.92%and 44.81%,respectively)were significantly higher than those in Day 6 blastocyst group(51.66%,38.69% and 28.83%,respectively)and Day 7 blastocyst group(32.26%,32.26% and 22.58%,respectively)(P<0.05).In Day 5,Day 6 and Day 7 blastocyst group,the live birth rate of blastocysts derived from Day 3 good quality embryo group was higher than that from Day 3 non-good quality embryo group(44.44%vs.39.53%,36.84%vs.27.10%,and 33.33%vs.20.00%,respectively),but there was no significant difference(P>0.05).In different age subgroups,the live birth rate of blastocyst transfer in<35 years group(43.89%)and 35-39 years group(34.25%)was significantly higher than that in≥40 years group(14.17%)(P<0.05),but there was no significant difference between Day 3 good quality embryo group and Day3 non-good quality embryo group in the same age subgroup(P>0.05).Conclusions:Prolonged culture of Day 3 non-good quality embryos to the blastocyst stage can obtain a certain live birth rate.Day 7 blastocyst derived from D3 good or non-good quality embryo can still obtain certain live birth rate after transfer.