高龄妇女分裂期胚胎质量分析及妊娠结局评估

Evaluation and Analysis of Cleavage Embryo Quality and Pregnancy Outcome in Elderly Women

目的:分析体外受精-胚胎移植阶段高龄妇女分裂期胚胎质量并探讨不同胚胎质量对妊娠结局的影响。方法:回顾性分析2018年10月至2020年10月235例高龄妇女的364个体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)周期。将胚胎分为早期卵裂(early cleavage,EC)胚胎组、2原核(2 pronucleus,2PN)合子组、2原核消失(2 pronucleus breakdown,2PNBD)组;依据移植胚胎卵裂数目分为2EC组、2Non-EC组、混合组;依据胚胎移植的具体情况可分为移植胚胎分裂模式正常(all split normal,ASN)组、移植胚胎中1个分裂模式正常和1个分裂模式异常(one split normal,OSN)组、移植胚胎分裂模式异常(all split abnormal,ASA)组,分别分析不同组别的胚胎质量、囊胚质量、发育过程中的异常状况。结果:早期卵裂组胚胎卵裂的发育速度和优胚率均高于2PN合子组和2PNBD组(P<0.05)。ASN组的优质胚胎率、囊胚形成率、优质囊胚率、可冻囊胚率均高于ASA组(P<0.05)。ASN组的种植率和临床妊娠率均高于OSN组和ASA组(P<0.05),三组的多胎妊娠率和早期流产率均无统计学差异(P>0.05)。结论:高龄妇女早期卵裂与优胚率和胚胎发育速度相关,胚胎分裂模式与妊娠结局的好坏密切相关,而卵裂观察与妊娠结局的好坏无关。

Objective To analyze the quality of embryos in split stage of elderly women in the stage of in vitro fertilization-embryo transfer(IVF-ET)and explore the effect of different embryo quality on pregnancy outcome.Methods 364 IVF-ET cycles of 235 elderly women from October 2018 to October 2020 were analyzed retrospectively.The embryos were divided into early cleavage(EC)embryo group,2 pronucleus(2PN)zygote group and 2 pronucleus breakdown(2PNBD)group.They were also divided into 2EC group,2Non-EC group and mixed group according to the number of cleavage of the transferred embryos.According to the specific situation of embryo transfer,the embryos can be divided into transfer embryos with normal split pattern(all split normal,ASN)group,transfer embryos with 1 split pattern normal and 1 split pattern abnormal(one split normal,OSN)group and the all split abnormal(ASA)group.The embryo quality,blastocyst quality,and abnormalities in the development process of different groups were analyzed respectively.Results The development speed of embryo cleavage and the rate of high-quality embryos in EC group were higher than those in 2PN zygote group and 2PNBD group(P<0.05).The rates of high-quality embryos,blastocyst formation,high-quality blastocysts,and freezable blastocysts in the ASN group were higher than those in the ASA group(P<0.05).The implantation rate and clinical pregnancy rate of the ASN group were higher than those of the OSN group and the ASA group(P<0.05),and there were no significant differences in the multiple pregnancy rate and early miscarriage rate among the three groups(P>0.05).Conclusion The early cleavage of the elderly women is related to the rate of excellent embryos and the rate of embryo development.The pattern of embryo division is closely related to the outcome of pregnancy,while the observation of cleavage is not related to the outcome of pregnancy.