冻融胚胎过夜培养后移植患者妊娠情况分析

Analysis of pregnancy status of patients transplanted with frozen-thawed embryos cultured overnight

目的观察冻融胚胎过夜培养后卵裂球增长及胚胎继续发育情况与患者临床妊娠率、种植率及早期流产率的关系。方法回顾性分析2018年1月至2019年3月在西安市第四医院生殖医学中心进行冻融胚胎移植患者的536个周期,依照移植的2枚胚胎过夜培养后(18~20h)有无卵裂球增长分为A2组(n=425)、A1组(n=89)、A0组(n=22)。再根据2枚胚胎均有卵裂球生长的A2组的卵裂球增长的数目及发育情况将其进一步分层为aa组、ab组、ac组、bb组和cc组5个小组,观察各组的临床妊娠率、胚胎种植率及流产率,统计分析各组的差异。结果(1)A2组、A1组、A0组的临床妊娠率分别为60.9%、36.0%、9.1%,差异有统计学意义(χ^(2)=37.76,P<0.05);3组的胚胎种植率分别为41.1%、21.3%、4.5%,差异有统计学意义(χ^(2)=44.73,P<0.05);3组的早期流产率差异无统计学意义(P>0.05)。(2)aa组的临床妊娠率(70.1%vs 50.9%)和胚胎种植率(49.2%vs 26.4%)均显著高于ac组,χ^(2)值分别为5.976、15.906,P<0.05;ab组的胚胎种植率(44.5%)显著高于ac组(26.4%),χ^(2)=9.839,P<0.05。(3)aa组的临床妊娠率(70.1%vs 36.8%)和胚胎种植率(49.2%vs 26.3%)均显著高于cc组,χ^(2)值分别为8.108、6.971,P<0.05;bb组的流产率(7.5%)显著低于cc组(42.9%),χ^(2)=3.890,P<0.05。结论冻融胚胎过夜培养后移植2个以上卵裂球均有增长,尤其是已经发生致密化、融合或者形成早期囊胚的胚胎,能获得较高的临床妊娠率、胚胎种植率和较低的流产率;单胚胎移植时可优先选择过夜培养后胚胎已经致密化、融合或者形成早期囊胚的胚胎。

Objective To explore the relationship between blastomere growth and embryo development after overnight culture of frozen-thawed embryos and clinical pregnancy rate,implantation rate and early abortion rate.Methods A retrospective analysis of 536 cycles of patients transferred with frozen-thawed embryo in the reproductive medicine center of Xi′an Fourth Hospital from January 2018 to March 2019 was performed.According to whether the blastomeres of two transplanted embryos cultured overnight have cleaved(18-20 h),the patients were divided into 3 groups:A2 group(n=425),A1 group(n=89)and A0 group(n=22).According to the number and development of blastomeres in the A2 group,A2 group was further divided into 5 groups:aa group,ab group,ac group,bb group and cc group.The clinical pregnancy rate,embryo implantation rate and abortion rate of each group were observed and statistically analyzed.Results(1)The clinical pregnancy rates of A2 group,A1 group and A0 group were 60.9%,36.0%and 9.1%,respectively,and the difference was statistically significant(χ^(2)=37.76,P<0.05).The embryo implantation rates of the three groups were 41.1%,21.3%and 4.5%,respectively,and the difference was statistically significant(χ^(2)=44.73,P<0.05).There was no significant difference in the early abortion rates among the three groups(χ^(2)=2.231,P>0.05).(2)The clinical pregnancy rate(70.1%vs 50.9%)and embryo implantation rate(49.2%vs 26.4%)of the aa group were significantly higher than those of the ac group,withχ^(2) values of 5.976 and 15.906,respectively,P<0.05.The embryo implantation rate of the ab group(44.5%)was significantly higher than the ac group(26.4%),withχ^(2) value of 9.839,P<0.05.(3)The clinical pregnancy rate(70.1%vs 36.8%)and embryo implantation rate(49.2%vs 26.3%)of the aa group were significantly higher than those of the cc group,withχ^(2) values of 8.108 and 6.971,respectively,P<0.05.The abortion rate of the bb group(7.5%)was significantly lower than the cc group(42.9%),withχ^(2) value of 3.890,P<0.05.Conclusion After the overnight culture of frozen-thawed embryos,transplantation of embryos with more than two blastomeres have grown,especially those which have densified,fused or formed early blastocyst,can obtain higher clinical pregnancy rate,implantation rate and lower abortion rate.Embryos that have densified,fused,or formed early blastocysts after overnight culture can be preferentially selected for single embryo transfer.