D3致密化胚胎的临床结局分析

Analysis of clinical outcomes of post-compaction embryos on Day 3

目的探讨取卵后第3日(D3)致密化胚胎的临床结局。方法回顾性分析2014年1月至2021年5月在解放军联勤保障部队第901医院生殖医学中心行IVF/ICSI助孕且D3有致密化胚胎形成的547个取卵周期及其331个移植周期的临床资料。根据D3移植胚胎形态,分为致密化胚胎组(n=26)和优质卵裂胚组(n=105),比较两组胚胎的囊胚形成率及优质囊胚形成率;根据囊胚移植周期D3胚胎来源,分为致密化胚胎来源囊胚组(n=67)和优质卵裂胚来源囊胚组(n=133),分别比较各组的临床结局,并采用二元Logistic回归分析早期流产率的影响因素。结果D3致密化胚胎与优质卵裂胚的囊胚形成率(69.57%vs.67.14%)及优质囊胚形成率(36.16%vs.33.83%)均无显著差异(P>0.05)。D3致密化胚胎组与优质卵裂胚组的临床妊娠率、种植率、持续妊娠率均无显著差异(P>0.05),但D3致密化胚胎组的早期流产率显著高于优质卵裂胚组(35.71%vs.5.26%,P<0.05);Logistic回归分析显示,早期流产率与移植胚胎质量(优质卵裂胚或致密化胚胎)有关(P=0.028)。不同D3胚胎来源的囊胚其临床妊娠率、早期流产率、种植率、持续妊娠率均无显著差异(P>0.05)。结论D3胚胎移植时建议选择优质卵裂胚,D3致密化胚胎建议行囊胚培养后移植。

Objective:To investigate clinical outcomes of post-compaction embryos on Day 3.Methods:The clinical data of 547 oocytes retrieved cycles with post-compaction embryos formation on Day 3 after fertilization in IVF/ICSI treatment and 331 embryo transfer cycles in the 901^(st) Hospital of the Joint Logistics Support Force of PLA from January 2014 to May 2021 were analyzed retrospectively.According to the embryo morphology on Day 3,the cycles were divided into post-compaction embryo group(n=26)and high-quality cleavage embryo group(n=105),and the blastocyst formation rate and good-quality blastocyst formation rate were compared between the two groups.According to Day 3 embryo source of blastocyst transfer cycle,the cycles were divided into blastocysts derived from post-compaction embryos group(n=67)and blastocysts derived from high-quality cleavage embryos group(n=133).The clinical outcomes were compared among the groups.Then,binary logistic regression was used to analyze the influencing factors of early abortion rate.Results:No significant differences were found in blastocyst formation rate(69.57%vs.67.14%)and good-quality blastocyst rate(36.16%vs.33.83%)between post-compaction embryos and good-quality cleavage-stage embryos on Day 3(P>0.05).There were no significant differences in the rates of clinical pregnancy,implantation and ongoing pregnancy between post-compaction embryos and good-quality cleavage-stage embryos(P>0.05),whereas the early abortion rate in post-compaction embryos group was significantly higher than good-quality cleavage-stage embryos group(35.71%vs.5.26%,P<0.05).Logistic regression analysis showed that the early abortion rate was significantly related to the quality of embryo transferred(good-quality cleavage-stage embryos or post-compaction embryos)(P=0.028).Furthermore,there were no significant differences in the clinical pregnancy rate,early abortion rate,implantation rate and ongoing pregnancy rate between the blastocysts from different sources of Day 3 embryos(P>0.05).Conclusions:For Day 3 embryo transfer,it is recommended to select high-quality cleavage embryo to transfer,while for Day 3 post-compaction embryo,it should be transplanted after blastocyst culture.