冻融D3胚胎培养至囊胚移植与冻融囊胚移植的临床结局比较

Comparison of clinical outcomes of blastocysts derived from frozen D3 embryos and frozen blastocysts

目的探讨冻融D3胚胎培养至囊胚进行移植与冻融囊胚移植的临床差异,为临床运用提供依据。方法回顾性分析2019年2月—2020年1月在金华市人民医院生殖医学中心接受冻融胚胎行囊胚培养移植和冻融囊胚移植的866位不孕患者的临床结局。其中玻璃化冷冻D3胚胎复苏后行囊胚培养364例(A组),冻融囊胚移植502例(B组),比较两组的临床妊娠率、种植率及早期流产率等指标;同时将囊胚移植的患者按照囊胚形成的天数分为D5和D6两组,比较两组的临床妊娠率、种植率及早期流产率等指标。结果A组的临床妊娠率、种植率及早期流产率等指标分别为(54.97%、44.09%、12.43%)与B组(56.44%、45.69%、12.68%)比较,差异无统计学意义(P>0.05),但取消周期率(11.54%)比B组(2.59%)高,差异有统计学意义(P<0.05)。在A组和B组中,D5囊胚的临床妊娠率分别为(63.25%、65.17%),种植率分别为(49.55%、53.55%),均高于D6囊胚[(32.95%、43.72%),(29.19%、35.07%)],差异有统计学意义(P<0.05),早期流产率分别为(9.46%、7.41%),显著低于D6组(27.59%、24.14%),差异有统计学意义(P<0.05)。结论在冻融胚胎移植周期中,冻融囊胚移植具有比冻融D3胚胎培养至囊胚进行移植更低的取消周期风险。移植D5囊胚的临床结局优于D6囊胚,因此在移植周期中应优先选用D5囊胚。

Objective To investigate the clinical outcomes of blastocyst implFantation by continuously sequential culture after vitrified frozen D3 cleavage embryo recovery and vitrified frozen blastocyst.Methods The clinical data of 866 patients,which including 364 cycles of blastocysts implantation by sequential culture after vitrified frozen D3 cleavage embryo recovery(group A)and 502 cycles of frozen-thawing vitrified frozen blastocyst implantation(group B)in Jinhua People's Hospital from February 2019 to January 2020,were retrospectively analyzed.The clinical pregnancy rates,miscarriage rates,and implantation rates were compared between the 2 groups.Also,the clinical pregnancy rates,miscarriage rates,and implantation rates were compared between D5-blastocyst-transfer group and D6-blastocys-transfer group.Results There were no differences in implantation rate,clinical pregnancy rate and early abortion rate between the group A(54.97%,44.09%,12.43%)and group B(56.44%,45.69%,12.68%),the difference was not statistically significant(P>0.05),but the cycle cancellation of group A(11.54%)was higher than group B(2.59%)for no blastocyst formation(P<0.05).In Group A and B,the clinical pregnancy rate of D5 blastocysts was(63.25%,65.17%),the implantation rate was(49.55%,53.55%),which was higher than that of D6 blastocysts[(32.95%,43.72%),(29.19%,35.07%)],the difference was statistically significant(P<0.05),and the early abortion rate was(9.46%,7.41%),significantly lower than that of D6 group(27.59%,24.14%),the difference was statistically significant(P<0.05).Conclusion In the period of frozen thawed embryo transfer,the risk of cycle cancellation of frozen thawed blastocyst transfer is lower than that of frozen thawed D3 embryo culture to blastocyst transfer.The clinical outcomes of D5 blastocysts is better than D6 blastocysts,so D5 blastocysts should be selected preferentially in the transplantation cycle.