“废弃”胚胎继续囊胚培养及其妊娠结局分析

Pregnancy outcomes of blastocysts from discarded embryos

目的探讨常规评价体系中的“废弃”胚胎继续囊胚培养后的临床价值。方法回顾性分析2015年1月至2020年1月在西北妇女儿童医院生殖中心第1次行IVF/ICSI-ET治疗、因D3无可利用胚胎(D3胚胎评分均为Ⅳ级或F级)而行囊胚“试培养”的246例患者的临床资料,并根据“试培养”结局不同分为成功组(54例)和失败组(192例),比较两组患者的基础资料及获卵情况;将成功形成囊胚并移植的患者根据其移植周期不同分为新鲜移植组(41例)和冻融移植组(10例),观察两组患者的妊娠结局。结果246例患者因D3无可移植胚胎行囊胚“试培养”,囊胚形成率和优质囊胚形成率分别为9.50%和5.85%。“试培养”失败组原发性不孕比例显著高于成功组(74.48%vs.57.41%,P<0.05)。54例患者获得囊胚后其中41例行新鲜周期囊胚移植(新鲜移植组),10例患者囊胚复苏成功,行冻融囊胚移植(冻融移植组)。新鲜周期组的临床妊娠率和活产率分别为53.66%和48.78%;冻融移植组的临床妊娠率为50.00%,自然流产率为60.00%,活产率为20.00%。所有新生儿均未见出生缺陷。结论“废弃”胚胎行囊胚培养具有一定的临床价值;对于D3无可用胚胎移植的患者,利用“废弃”胚胎行囊胚“试培养”不失为一种补救治疗的方法。

Objective:To investigate the clinical values of blastocysts from“discarded embryos”.Methods:The laboratory and clinical data of 246 patients with no available embryos(Day 3 embryo scores IV or F)and trying blastocyst culture in the Reproductive Center of Northwest Women’s and Children’s Hospital from January 2015 to January 2020 were analyzed.The patients were divided into success group(n=54)and failure group(n=192)according the blastocyst culture results.Their basic data and oocyte retrieved status of the two groups were compared.The patients with successful blastocyst formation and transplantation were divided into fresh transplantation group(n=41)and frozen-thawed transplantation group(n=10).The pregnancy outcomes of the two groups were observed.Results:Two hundred and forty-six patients underwent blastocysts culture due to no transplantable embryos on Day 3.The blastocyst formation rates and high-quality blastocyst formation rates were 9.50%and 5.85%respectively.The proportion of primary infertility in the blastocyst culture failure group was significantly higher than that in the blastocyst culture success group(74.48%vs.57.41%,P<0.05).Among 54 patients obtained blastocysts,41 patients underwent fresh blastocyst transfer and 10 patients with successful blastocyst resuscitation underwent frozen-thawed blastocyst transfer.The clinical pregnancy rate and live birth rate of fresh blastocyst transfer were 53.66%and 48.78%respectively.The clinical pregnancy rate of frozen-thawed blastocyst transfer was 50.00%,the miscarriage rate was 60.00%and live birth rate was 20.00%.No birth defects were found in all newborns.Conclusions:It has a certain clinical value to use the“discarded embryos”for blastocyst culture.For patients without transplantable embryos on Day 3,the use of“discarded embryos”for blastocyst culture is a remedial treatment.