短时体外受精新鲜移植周期中未见原核与单原核来源胚胎的临床价值

Clinical value of embryos derived from non-pronucleus zygotes and one pronucleus zygotes in short-term in vitro fertilization fresh transplant cycles

目的 分析短时体外受精新鲜移植周期中未见原核(0PN)和单原核(1PN)来源胚胎的临床妊娠情况,探讨这部分胚胎的临床应用价值。方法 回顾性分析2016年1月至2020年1月在海军军医大学(第二军医大学)第一附属医院生殖医学中心接受短时体外受精-胚胎移植治疗的524例不孕症患者共524个新鲜移植周期的实验室资料。按胚胎来源将移植周期分为A组和B组,A组均为0PN或1PN来源胚胎,B组均为双原核(2PN)来源胚胎。将胚胎移植个数为单胚胎者分为A1组和B1组,A1组为0PN或1PN来源胚胎,B1组为2PN来源胚胎;将胚胎移植个数为双胚胎者分为A2组和B2组,A2组为0PN+0PN、1PN+1PN或1PN+0PN来源胚胎,B2组为2PN+2PN来源胚胎。分别比较A组与B组、A1组与B1组、A2组与B2组的临床、实验室数据及妊娠结局。结果 B组的周期获卵数大于A组,B2组的周期获卵数大于A2组,差异均有统计学意义(P均<0.01);A1组与B1组周期获卵数差异无统计学意义(P>0.05)。A组与B组、A1组与B1组及A2组与B2组的种植率、临床妊娠率、流产率及活产率差异均无统计学意义(P均>0.05)。结论 在短时体外受精新鲜移植周期中,周期获卵数较多的周期获得2PN来源胚胎的可能性较大。0PN或1PN来源胚胎与2PN来源胚胎在短时体外受精新鲜移植周期中的妊娠结局无明显差异,可以在患者知情同意后移植0PN或1PN来源的胚胎。

Objective To analyze the clinical pregnancy status of embryos derived from non-pronucleus(0PN) zygotes and one pronucleus(1PN) zygotes in short-term in vitro fertilization(IVF) fresh transplant cycles, and to explore the clinical value of these embryos. Methods The laboratory data of 524 fresh transplant cycles of 524 infertile patients who received short-term IVF-embryo transfer treatment at Department of Reproductive Medicine, The First Affiliated Hospital of Naval Medical University(Second Military Medical University) from Jan. 2016 to Jan. 2020 were retrospectively analyzed.The transfer cycles were divided into group A and group B according to the embryo source. The embryos in group A were derived from 0PN or 1PN zygotes, and those in group B were derived from two pronuclei(2PN) zygotes. According to the number of embryos transferred, the single-embryo transferred ones were divided into group A1(with embryos derived from 0PN or 1PN zygotes) and group B1(with embryos derived from 2PN zygotes);and the double-embryo transferred ones were divided into group A2(with embryos derived from 0PN+0PN zygotes, 1PN+1PN zygotes, or 1PN+0PN zygotes) and group B2(with embryos derived from 2PN+2PN zygotes). Clinical and laboratory data and pregnancy outcomes were compared between groups A and B, A1 and B1, and A2 and B2, respectively. Results The numbers of eggs obtained per cycle in group B and group B2 were significantly greater than those in group A and group A2, respectively(both P<0.01), while there was no significant difference between group A1 and group B1(P>0.05). There were no significant differences in implant rate,clinical pregnancy rate, abortion rate or live birth rate between group A and group B, group A1 and group B1, or group A2 and group B2(all P>0.05). Conclusion In the short-term IVF fresh transfer cycle, the cycle with more number of eggs obtained per cycle is more likely from embryos derived from 2PN zygotes. There is no significant difference in pregnancy outcome between embryos derived from 0PN/1PN zygotes and 2PN zygotes in short-term IVF fresh transfer cycle. Embryos derived from 0PN/1PN zygotes can be transferred with informed consent of the patient.