冻融囊胚行复苏周期胚胎移植策略分析

The strategy of the freeze-thaw blastocyst transfer in the resuscitation cycles

目的分析复苏周期移植不同发育天数与不同个数囊胚的临床妊娠结局,评估不同冻融囊胚移植方案的临床应用价值,为冻融囊胚行复苏周期优选胚胎移植策略提供依据。方法回顾性分析2016年1月至2020年12月在安徽省妇幼保健院生殖医学中心首次接受体外受精-胚胎移植(IVF-ET)治疗且首次行复苏周期移植第5天(D5)或第6天(D6)冻融囊胚的患者共851个周期,根据选取囊胚的不同分为D5双囊胚组(263个周期)、D5单囊胚组(446个周期)、D6双囊胚组(48个周期)和D6单囊胚组(94个周期),对各组移植后的临床相关情况进行分析。结果四组年龄、不孕年限、体重指数、内膜厚度及囊胚评分比较,差异无统计学意义(P>0.05);D6单囊胚组妊娠率、种植率显著低于D5单囊胚组、D5双囊胚组、D6双囊胚组,差异具有统计学意义(P<0.05);D5双囊胚组多胎妊娠率显著高于D5单囊胚组、D5双囊胚组、D6双囊胚组,差异具有统计学意义(P<0.01);四组流产率比较,差异无统计学意义(P>0.05)。结论冻融囊胚首次行复苏周期移植时,应优先考虑D5单囊胚移植,从而保障母婴安全、减少多胎妊娠;对于冻融D6囊胚而言,可优先考虑移植两枚,以达到改善患者临床妊娠结局的目的。

Objective To analyze the clinical pregnancy outcomes of different developmental days and different numbers of blastocysts,and evaluate the clinical application value of different freeze-thaw blastocysts,so as to provide a basis for embryo transfer strategy of freeze-thaw blastocysts in the resuscitation cycle.Methods A total of 851 cycles of in vitro fertilization and embryo transfer(IVF-ET)patients who received freeze-thaw blastocysts on day 5(D5)or day 6(D6)of resuscitation cycle transfer were retrospectively analyzed in the Center of Reproductive Medicine of Anhui Maternal and Child Health Hospital from January 2016 to December 2020.According to the different selected blastocysts,they were divided into D5 double blastocyst group(263 cycles),D5 single blastocyst group(446 cycles),D6 double blastocyst group(48 cycles)and D6 single blastocyst group(94 cycles),and the clinical related situation of each group after transfer was analyzed.Results There were no significant differences in age,infertility years,body mass index,endometrial thickness and blastocyst score among the four groups(P>0.05).The pregnancy rate and transfering rate in D6 single blastocyst group were significantly lower than those in D5 single blastocyst group,D5 double blastocyst group and D6 double blastocyst group(P<0.05).The multiple pregnancy rate of D5 double blastocyst group was significantly higher than that of D5 single blastocyst group,D5 double blastocyst group and D6 double blastocyst group(P<0.01).There was no significant difference in abortion rate among the four groups(P>0.05).Conclusions D5 single blastocyst transfer should be given priority in the first resuscitation cycle transfer of freeze-thaw blastocyst,so as to improve maternal and infant safety and reduce multiple pregnancy.For freeze-thaw D6 blastocysts,two blastocysts can be transplanted first to improve the clinical pregnancy outcome.