解冻复苏囊胚行植入前遗传学检测临床结局分析

Clinical outcomes of preimplantation genetic testing of vitrification-thawing blastocysts

目的分析二次冷冻、二次活检(DFDB)囊胚和二次冷冻、一次活检(DFSB)囊胚行植入前遗传学检测(PGT)的临床结局相关资料,旨在扩大现有数据,为冻融胚胎PGT的临床价值和安全性问题提供一定的指导。方法回顾性分析38例行解冻复苏囊胚患者的PGT周期临床资料,依据囊胚活检次数的不同,分为DFDB组和DFSB组。冷冻方法均为玻璃化冷冻。结果DFDB组共24例患者,上个PGT周期未获诊断的囊胚共34枚,解冻后存活32枚,解冻囊胚存活率为94.12%。这32枚囊胚二次活检后,行遗传学检测,正常囊胚15枚(46.88%),异常囊胚数17枚(53.13%)。DFSB组共14例患者,共解冻复苏上个单精子胞浆内显微注射(ICSI)周期剩余的50枚囊胚,50枚囊胚解冻后均存活。活检这50枚囊胚,再进行遗传学分析,47枚囊胚诊断明确,其中正常囊胚9枚(18%),异常囊胚28枚(56.00%),嵌合体囊胚为10枚(20.00%),未获诊断的囊胚数为3枚(6.00%)。DFDB组和DFSB组分别有8例患者和5例患者解冻移植,解冻后囊胚均存活,分别临床妊娠5例和3例,各活产1例,活产婴儿均健康。结论DFDB、DFSB胚胎均可获得可接受的妊娠率,有其应用的临床价值。但是该研究样本量较小,故还需要扩大样本量,进一步探索其安全性。

Objective To analyze the data related to the clinical outcome of preimplantation genetic testing(PGT)for double frozen,double biopsied blastocysts and double frozen,once biopsied blastocysts,in order to expand the existing data and provide some guidance for the clinical value and safety of PGT for frozen-thawed embryos.Methods Retrospective analysis was made on the 38 PGT cycles of frozen-thawed blastocysts.According to the frequency of biopsy,cases in the study were divided into two groups:double frozen,double biopsy(DFDB)group and double frozen,single biopsy(DFSB)group.The freezing method was vitrification.Results There were 24 patients in DFDB group,34 blastocysts were not diagnosed in the last PGT cycle,32 blastocysts survived after thawing,and the survival rate of thawed blastocysts was 94.12%.After the second biopsy of these 32 blastocysts,genetic testing was performed,and all of them were definitely diagnosed,including 15 normal blastocysts(46.88%)and 17 abnormal blastocysts(53.13%).There were 14 patients in DFSB.The remaining 50 blastocysts in the last ICSI cycle were thawed and all blastocysts survived after thawing.Biopsy of these 50 blastocysts and genetic analysis showed that 47 blastocysts were diagnosed,including 9 normal blastocysts(18.00%),28 abnormal blastocysts(56.00%),10 mosaic blastocysts(20.00%),and 3 undiagnosed blastocysts(6.00%).In DFDB group and DFSB group,8 patients and 5 patients transferred the normal blastocystswhich all survivedafter thawing.There were 5 clinical pregnancies and 3 clinical pregnancies,respectively.One healthy live birth was obtained respectively in each group.Conclusion Acceptable pregnancy rate can be obtained whatever DFSB or DFDB blastocyst,which is of clinical value.However,due to the small sample size,we need to expand the sample size to further explore its safety.