D4胚胎发育速度对体外受精-胚胎移植妊娠结局的影响

Effect of Day 4 embryo development speed on pregnancy outcome in IVF-ET

目的探讨受精后培养至第4天(D4)胚胎的发育速度对体外受精-胚胎移植(IVF-ET)妊娠结局的影响。方法回顾性分析2019年1月至2022年6月期间在邢台不孕不育专科医院生殖医学中心行IVF-ET治疗的471个周期D4胚胎移植临床资料。根据移植胚胎发育速度分为3组:部分融合组、完全融合组及早期囊胚组;又根据移植胚胎数量不同分为单胚胎移植组和双胚胎移植组。比较不同胚胎移植数目下不同发育速度亚组间患者基本资料、胚胎受精及发育情况、妊娠结局等,采用二元Logistic回归分析临床妊娠的影响因素。结果各组间患者年龄、不孕年限、基础性激素水平、HCG日激素水平等均无显著性差异(P>0.05)。单胚胎移植组中,早期囊胚组的获卵数显著高于部分融合组[(13.35±4.76)vs.(9.64±3.23)枚,P<0.05],D3可用胚胎率显著高于完全融合组(74.96%vs.64.90%,P<0.05);双胚胎移植组中,早期囊胚组的D3可用胚胎率(81.03%)显著高于部分融合组(70.38%)和完全融合组(70.92%)(P<0.05)。单胚胎移植或双胚胎移植组中,随着移植胚胎速度逐渐增快(从部分融合到早期囊胚),不同亚组间临床妊娠率和种植率逐渐增高。双胚胎移植组中,早期囊胚组的临床妊娠率(79.69%)显著高于部分融合组(58.52%)和完全融合组(60.53%)(P<0.05),种植率显著高于部分融合组(60.16%vs.40.06%,P<0.05);完全融合组及早期囊胚组的多胎率有高于部分融合组的趋势,但尚无显著性差异(P>0.05)。双胚胎移植组中的部分融合组和完全融合组的妊娠率无显著性差异(P>0.05),但均显著高于单胚胎移植组中的完全融合组(P<0.05)。Logistic回归分析结果显示D4移植胚胎级别对临床妊娠有显著影响(P<0.05)。结论IVF-ET中,随着D4胚胎发育速度增快,临床妊娠率和种植率逐渐增高;D4胚胎移植应优选早期囊胚,其次是完全融合胚;D4发育到完全融合及以上级别的胚胎建议行单胚胎移植以降低多胎率,对部分融合胚则建议移植两枚。

Objective:To investigate the effect of Day 4 embryo development speed on pregnancy outcome in IVF-ET.Methods:The data of 471 cycles treated in the reproductive center of Xingtai Infertility Specialist Hospitals from January 2019 to June 2022 were retrospectively analyzed.The cycles were divided into three groups:partial compaction embryo,full compaction embryo and early blastocyst groups.The cycles were also divided into single embryo transfer group and two embryos transfer group based on the number of embryos transferred.The basic information,fertilization and development status of embryos,and pregnancy outcomes among the patients of subgroups with different number of embryos transferred and different embryo development speed.The binary logistic regression was used to analyze the influencing factors of clinical pregnancy.Results:There were no significant differences in patients’age,infertility years,basal sex hormone levels,and hormone levels on HCG day among the groups.In the single embryo transfer group,the number of oocytes retrieved in the early blastocyst group was significantly higher than that in the partial compaction group[(13.35±4.76)vs.(9.64±3.23),P<0.05],and the available Day 3 embryo rate was significantly higher than that in the full compaction group(74.96%vs.64.90%,P<0.05).In the two embryos transfer group,the available Day 3 embryo rate in the early blastocyst group(81.03%)was significantly higher than that in the partial compaction group(70.38%)and the full compaction group(70.92%)(P<0.05).In the single embryo transfer or two embryos transfer group,as the development speed of embryo transferred gradually increased(from partial compaction to early blastocyst),the clinical pregnancy rate and implantation rate gradually increased among the different subgroups.In the two embryos transfer group,the pregnancy rate(79.69%)of the early blastocyst group was significantly higher than that of the partial compaction group(58.52%)and the full compaction group(60.53%)(P<0.05),and the implantation rate was significantly higher than that of the partial compaction group(60.16%vs.40.06%,P<0.05).The multiple pregnancy rate in the full compaction group and early blastocyst group showed a higher trend than that in the partial compaction group,but there was no significant difference(P>0.05).In the two embryos transfer group,there was no significant difference in pregnancy rates between the partial compaction group and the full compaction group(P>0.05),but both were significantly higher than the full compaction group in the single embryo transfer group(P<0.05).The results of logistic regression analysis showed that the grade of Day 4 embryo transferred had a significant impact on clinical pregnancy(P<0.05).Conclusions:The pregnancy rate and implantation rate are significantly increased with the increase of Day 4 embryo development speed.Early blastocysts should be preferred for Day 4 embryo transfer,followed by fully compaction embryos.To reduce the multiple birth rate,single embryo transfer is recommended for embryos developed to full compaction or above,while two partial compaction embryos are recommended to be transferred.