两细胞多核胚胎对活产结局的影响

Effects of two-cell multinucleated embryos on live birth

目的观察解冻复苏单囊胚移植周期中移植两细胞多核胚胎来源囊胚对胚胎发育及活产结局的影响,探究两细胞多核胚胎来源囊胚的临床应用价值。方法回顾性分析2020年7月至2021年11月于重庆市妇幼保健院生殖医学中心进行解冻复苏单囊胚移植患者(共663个周期)的临床妊娠和活产结局数据,并利用时差培养数据分析相应胚胎的胚胎发育数据。依据两细胞阶段是否存在多核现象分为两细胞无多核组(A组,n=547)和两细胞多核组(B组,n=116);又根据多核现象的分布情况将两细胞多核组分为两细胞1细胞多核组(B1组,n=75)和两细胞2细胞多核组(B2组,n=41),根据胚胎发育过程中多核现象的存在情况将两细胞多核组分为四细胞无多核组(B3组,n=96)和四细胞多核组(B4组,n=20)。比较A、B两组间的一般资料、胚胎发育情况、妊娠结局及新生儿情况。结果A、B两组患者的一般资料中除不同内膜准备方案(包括人工周期和自然周期)占比有显著性差异(P<0.05)外,其余指标均无显著性差异(P>0.05);两组间卵巢刺激天数、Gn剂量、扳机日雌二醇(E 2)水平、子宫内膜厚度及获卵数等比较均无显著性差异(P>0.05),仅不同受精方式(包括IVF、ICSI和补救ICSI)占比有显著性差异(P<0.05);两组间Day 2正常卵裂胚胎比率、Day 3优质胚胎率及优质囊胚率等均无显著性差异(P>0.05);两组间HCG阳性率、临床妊娠率、流产率、早产率、活产率及新生儿体重、身长及性别比均无显著性差异(P>0.05)。多元回归分析结果表明B、B1、B2、B3及B4组与A组间的临床妊娠率、流产率及活产率亦无显著性差异(P>0.05)。结论两细胞多核对胚胎发育及其形成的囊胚移植后的活产结局均无明显不良影响,两细胞多核胚胎发育形成的囊胚仍具有一定的临床应用价值。

Objective:To observe the impact of blastocyst transfer which derived from two-cell multinucleated embryo during the frozen-thawed single blastocyst transfer cycle on embryonic development and newborn status,and explore the clinical application values of blastocysts derived from two-cell multinucleated embryo.Methods:The clinical outcomes and live birth outcome of 663 frozen-thawed single blastocyst transfer cycles in the Reproductive Medicine Center of Chongqing Health Center for Women&Children from July 2020 to November 2021 were retrospectively analyzed.The embryonic development data of the corresponding embryos were analyzed by time-lapse data.According to whether multinucleation occurred at the two-cell stage,the transplanted blastocysts were divided into two-cell non-multinucleation group(group A,n=547)and two-cell multinucleation group(group B,n=116).Then,the two-cell multinucleation group was subdivided into two-cell with one cell multinucleation group(group B1,n=75)and two-cell with two cells multinucleation group(group B2,n=41)according to the distribution of multinucleation.The two-cell multinucleation group was subdivided into four-cell non-multinucleation group(group B3,n=96)and four-cell multinucleation group(group B4,n=20)according to the presence of multinucleation during embryonic development.The basic data,embryonic development,clinical outcome and newborn status were compared between group A and B.Results:There were no significant differences in the basic characteristics between A and B groups(P>0.05),except the proportion of different endometrial preparation protocols including artificial cycle and natural cycle was significantly different(P<0.05).There were also no significant differences in ovarian stimulation days,Gn dose,estradiol(E 2)level on trigger day,endometrial thickness,and number of retrieved oocytes(P>0.05),but there was significant difference in the proportion of different fertilization methods(including IVF,ICSI,and rescue ICSI)(P<0.05).There were no significant differences in normal cleavage embryo rate on Day 2,high-quality embryo rate and high-quality blastocyst rate on Day 3 between A and B groups(P>0.05).There were also no significant differences in HCG positive rate,clinical pregnancy rate,miscarriage rate,prematurity rate,live birth rate,neonatal weight,neonatal body length,and neonatal sex ratio between the two groups(P>0.05).Besides,the multiple regression analysis results indicated that there were also no significant differences in clinical pregnancy rate,miscarriage rate,and live birth rate between the group B,B1,B2,B3,B4 and group A(P>0.05).Conclusions:Two-cell multinucleation had no adverse effects on embryonic development and the live birth outcome of transplanted blastocysts derived from two-cell multinucleated embryos.The blastocysts derived from two-cell multinucleated embryos still have certain clinical application values.