0PN来源胚胎形成的影响因素及其利用价值分析

Analysis of influencing factors and utilization value of 0PN-derived embryo formation

目的探讨常规体外受精(IVF)后的未见原核(0PN)受精卵发生的影响因素及对其发育潜能影响。方法对2019年1月至2021年12月期间在保定市妇幼保健院生殖医学科1597个常规IVF周期及596个冻融胚胎移植(FET)周期进行回顾分析。将常规IVF-ET周期分为A1组(无0PN来源胚胎,n=731)、A2组(0<0PN来源胚胎率≤20%,n=495)和A3组(0PN来源胚胎率>20%,n=371)三组,比较三组的患者基本情况、新鲜周期临床治疗情况和实验室指标。依据行囊胚培养的D3卵裂胚来源不同分为B1组(0PN来源,n=2409)和B2组(2PN来源,n=6602)两组,比较两组囊胚形成率、可利用囊胚形成率。依据囊胚来源将囊胚FET周期分为C1组(0PN来源冻融囊胚,n=85)和C2组(2PN来源冻融囊胚,n=511),比较两组的妊娠率、着床率、流产率、活产率、胎儿畸形率等指标。结果(1)与A1组比较,A2、A3组的年龄更小、基础FSH水平更低、抗苗勒管激素(AMH)水平更高(P<0.05),而组间不孕年限、体质量指数(BMI)无显著差异(P>0.05)。A2、A3组两组患者用药天数、长方案占比、获卵数显著高于A1组(P<0.05),其中A2组拮抗剂方案占比最低,获卵数最高。(2)B1、B2两组的囊胚形成率无显著差异(P>0.05),B1组的可利用囊胚形成率显著高于B2组(P<0.05)。(3)FET周期中,C1、C2组患者间年龄、不孕年限、BMI、优质囊胚比例、D5囊胚占比均无显著差异(P>0.05),C2组的移植胚胎数显著高于C1组(P<0.05)。囊胚移植后,两组间种植率、妊娠率、孕周、早产率、新生儿体重、新生儿体长比较均无显著差异(P>0.05),C1组流产率显著高于C2组、活产率显著低于C2组(P<0.05)。结论接受常规IVF-ET治疗的患者卵巢储备情况可能会对0PN来源胚胎的形成有一定影响;0PN来源囊胚移植流产率高于2PN来源囊胚,而活产率低于2PN来源囊胚,但在患者无2PN来源胚胎可移植的情况下,0PN来源囊胚移植提高了胚胎利用率,降低了患者诊疗费用,减少了患者精神及身体上的痛苦,有很大利用价值。

Objective:To investigate the influencing factors and developmental potential of non-pronuclear(0PN)fertilized oocytes after conventional IVF.Methods:A retrospective analysis was conducted on 1597 conventional IVF cycles and 596 frozen-thawed embryo transfer(FET)cycles in the Reproductive Medicine Department of Baoding Maternal&Child Health Center from January 2019 to December 2021.The conventional IVF cycle were divided into three groups:group A1(no 0PN derived embryo,n=731),group A2(0<0PN derived embryo rate≤20%,n=495),and group A3(0PN derived embryo rate>20%,n=371).The basic patient information,clinical treatment status in fresh cycle,and laboratory indicators were compared among the three groups.According to the different sources of Day 3 cleavage embryos for blastocyst culture,the cycles were divided into two groups:group B1(0PN-derived,n=2409)and group B2(2PN-derived,n=6602).The blastocyst formation rate and available blastocyst formation rate of the two groups were compared.According to the source of blastocysts,the frozen-thawed blastocyst transfer cycle was divided into group C1(0PN frozen-thawed blastocysts,n=85)and group C2(2PN frozen-thawed blastocysts,n=511).The pregnancy rate,implantation rate,miscarriage rate,live birth rate,fetal malformation rate,and other indicators were compared between the two groups.Results:Compared with group A1,the group A2 and A3 had younger age,lower basal FSH levels,and higher anti-Mullerian hormone(AMH)levels(P<0.05),while there was no significant difference in infertility years or body mass index(BMI)(P>0.05).The duration of medication,proportion of long protocol,and number of oocytes retrieved in the group A2 and A3 were significantly higher than those in the group A1(P<0.05).Among them,the group A2 had the lowest proportion of GnRH antagonist protocol and the highest number of oocytes retrieved.There was no significant difference in the blastocyst formation rate between the group B1 and B2(P>0.05),while the available blastocyst formation rate in the group B1 was significantly higher than that in the group B2(P<0.05).In the FET cycles,there was no significant difference in age,infertility years,BMI,proportion of high-quality blastocysts,and proportion of Day 5 blastocysts between the group C1 and C2(P>0.05).The number of embryos transferred in the group C2 was significantly higher than that in the group C1(P<0.05).After blastocyst transplantation,there were no significant differences in implantation rate,pregnancy rate,gestational age,preterm birth rate,newborn weight,and newborn body length between the two groups(P>0.05).The abortion rate in group C1 was significantly higher than that in group C2,and the live birth rate was significantly lower than that in group C2(P<0.05).Conclusions:The ovarian reserve status of patients receiving conventional IVF-ET may have a certain impact on the formation of 0PN-derived embryos.The abortion rate of 0PN-derived embryo transfer is higher than that of 2PN-derived embryo transfer,while the live birth rate is lower than that of 2PN-derived embryo transfer.However,in the absence of 2PN-derived embryos that can be transferred to the patients,0PN-derived embryo transfer improves embryo utilization rate,reduces patient diagnosis and treatment costs,reduces patient mental and physical pain,and has great utilization value.