整倍体胚胎形态动力学参数对单囊胚移植妊娠结局的影响

Effect of euploid embryo morphokinetic parameters on pregnancy outcome of single blastocyst transfer

目的探究胚胎发育过程中的形态动力学参数对整倍体单囊胚移植后妊娠结局的影响。方法回顾性队列研究分析2019年1月至2021年6月期间于重庆医科大学附属妇女儿童医院生殖医学中心接受胚胎植入前遗传学检测-整倍体囊胚解冻复苏移植治疗的394例患者临床资料。根据妊娠结局分为未着床组(n=153)、临床流产组(n=16)和活产组(n=225)。比较各组患者的一般资料、胚胎质量及形态动力学参数的差异。结果未着床组女性的年龄[(32.51±4.08)岁]大于活产组患者[(31.34±4.23)岁,P=0.025],优质胚胎率[26.80%(41/153)]低于活产组[42.22%(95/225),P=0.007]。与临床流产组相比,未着床组的体质量指数、优质胚胎率差异均无统计学意义(均P>0.05)。三组间的形态动力学参数原核出现时间(time to pronuclei appearance,tPNa)、原核消失时间(time to PN fading,tPNf)、2-细胞时间(time to 2-cell,t2)、t3、t4及t8差异均无统计学意义(均P>0.05)。未着床组胚胎的桑椹胚融合时间(timing of compacted morula,tM)[(86.96±7.59)h]、开始形成囊胚腔的时间[(96.73±7.20)h)]均显著高于活产组[(85.00±7.00)h,P=0.010;(95.14±7.30)h,P=0.037]和临床流产组[(82.89±6.33)h,P=0.040;(93.02±6.10)h,P=0.048]。校正年龄和胚胎质量因素后,二元logistic回归结果显示形态动力学参数对着床和活产结局差异均无统计学意义(均P>0.05)。结论胚胎发育过程中的形态动力学参数不影响整倍体单囊胚移植的妊娠结局,不能用于预测整倍体囊胚移植的妊娠结局。

Objective To explore the effect of morphokinetic parameters during embryo development on pregnancy outcome of euploid single blastocyst transfer cycles,and to evaluate the predictive value of morphokinetic parameters for selective euploid single blastocyst transfer strategy.Methods A retrospective cohort study was conducted to analyze the clinical data of 394 patients who received preimplantation genetic testing-frozen-thawed embryo transfer(PGT-FET)in Center for Reproductive Medicine of Women and Children's Hospital of Chongqing Medical University from January 2019 to June 2021.According to the pregnancy outcomes,the patients were divided into non-implantation group(n=153),clinical miscarriage group(n=16)and live birth group(n=225).The patients'baseline characteristics,embryo quality and morphokinetic parameters were compared among the three groups.Results The maternal age in the non-implantation group[(32.51±4.08)years]was significantly higher than that in the live birth group[(31.34±4.23)years,P=0.025],and the proportion of high-quality embryos in the non-implantation group[26.80%(41/153)]was significantly lower than that in the live birth group[42.22%(95/225),P=0.007].There were no significant differences in the body mass index and the proportion of high-quality embryos between the clinical miscarriage group and the non-implantation group(P>0.05).There was no significant difference in the proportion of high-quality embryos between the clinical miscarriage group and the non-implantation group(P>0.05).There were no significant differences in the morphokinetic parameters of time to pronuclei appearance(tPNa),time to PN fading(tPNf),time to 2-cell(t2),t3,t4 and t8 among the three groups(all P>0.05).The average timing of compacted morula(tM)[(86.96±7.59)h]and timing of starting blastulation(tSB)[(96.73±7.20)h]of embryos in the non-implantation group were significantly higher than those in the live birth group[(85.00±7.00)h,P=0.010;(95.14±7.30)h,P=0.037,respectively]and the clinical miscarriage group[(82.89±6.33)h,P=0.040;(93.02±6.10)h,P=0.048].After adjusting for age and embryo quality,the regression analysis showed that the morphokinetic parameters had no significant effect on implantation results(all P>0.05).Conclusion The morphokinetic parameters during embryonic development do not affect the pregnancy outcome of euploid single blastocyst transfer and cannot be used to predict the pregnancy outcome of euploid blastocyst transfer.