卵裂期优质胚胎与非优质胚胎来源的囊胚冻融移植后着床率比较

Comparison of implantation rate of blastocyst between high-quality embryos and non-high-quality embryos during cleavage stage after freeze-thaw transfer

目的比较卵裂期优质胚胎与非优质胚胎来源的囊胚进行冻融囊胚移植(FET)的囊胚着床率,探讨卵裂期非优质胚胎来源的囊胚移植价值。方法选择2018年1月至2022年1月于山东中医药大学第一附属医院生殖与遗传中心行FET的613枚受精后5 d(D_(5))囊胚为研究对象,根据其在受精后3 d(D_(3))是否为优质胚胎将其分为优质组(n=158)和非优质组(n=455)。分别比较2组不同内膜准备方案、囊胚腔不同扩张程度、不同级别内细胞团(ICM)、不同级别滋养外胚层(TE)的囊胚着床率以及不同等级囊胚的着床率。结果优质组囊胚着床率为37.97%(60/158);其中自然周期方案、替代周期方案、降调节+替代周期方案、促排卵周期方案的囊胚着床率分别为38.30%(18/47)、41.82%(23/55)、36.67%(11/30)、30.77%(8/26);优质组4种内膜准备方案的囊胚着床率比较差异无统计学意义(χ^(2)=0.942,P>0.05)。非优质组囊胚着床率为33.41%(152/455);其中自然周期方案、替代周期方案、降调节+替代周期方案、促排卵周期方案的囊胚着床率分别为31.01%(40/129)、32.43%(36/111)、23.30%(7/30)、37.30%(69/185);非优质组4种内膜准备方案的囊胚着床率比较差异无统计学意义(χ^(2)=3.008,P>0.05)。优质组与非优质组的囊胚着床率以及自然周期方案、替代周期方案、降调节+替代周期方案、促排卵周期方案的囊胚着床率比较差异均无统计学意义(χ^(2)=1.082、0.829、1.414、1.270、0.419,P>0.05)。优质组中囊胚腔扩张程度2级、3级、4级、5级的囊胚着床率分别为6.25%(1/16)、35.40%(25/71)、46.38%(32/69)、0.00%(0/2);囊胚腔扩张程度3、4级的囊胚着床率高于2级(χ^(2)=5.227、8.805,P<0.05);囊胚腔扩张程度3级与4级囊胚着床率比较差异无统计学意义(χ^(2)=1.807,P>0.05)。非优质组中囊胚腔扩张程度2级、3级、4级、5级的囊胚着床率分别为40.43%(19/47)、31.07%(64/206)、34.03%(65/191)、36.36%(4/11);非优质组中不同囊胚腔扩张程度的胚囊着床率比较差异无统计学意义(χ^(2)=1.624,P>0.05)。非优质组中囊胚腔扩张2级的囊胚着床率显著高于优质组(χ^(2)=6.434,P<0.05);优质组与非优质组中囊胚腔扩张3、4、5级的囊胚着床率比较差异均无统计学意义(χ^(2)=0.416、3.303、1.051,P>0.05)。优质组中ICM A级、B级、C级的囊胚着床率分别为16.67%(1/6)、40.58%(56/138)、21.43%(3/14);优质组中不同ICM等级的囊胚着床率比较差异无统计学意义(χ^(2)=3.181,P>0.05)。非优质组中ICM A级、B级、C级的囊胚着床率分别为28.57%(2/7)、34.07%(138/405)、27.90%(12/43);非优质组中不同ICM等级的囊胚着床率比较差异无统计学意义(χ^(2)=0.739,P>0.05)。优质组与非优质组中ICM A、B、C级的囊胚着床率比较差异均无统计学意义(χ^(2)=0.258、1.897、0.229,P>0.05)。优质组中TE A级、B级、C级的囊胚着床率分别为37.50%(6/16)、36.28%(41/113)、44.83%(13/29);优质组中不同TE等级的囊胚着床率比较差异无统计学意义(χ^(2)=0.713,P>0.05)。非优质组中TE A级、B级、C级的囊胚着床率分别为73.33%(11/15)、36.16%(111/307)、22.56%(30/133);非优质组中TE A级的囊胚着床率显著高于B级和C级(χ^(2)=8.399、17.353,P<0.05),TE B级的囊胚着床率显著高于C级(χ^(2)=7.882,P<0.05)。非优质组中TE A级的囊胚着床率显著高于优质组(χ^(2)=4.014,P<0.05),非优质组中TE C级的囊胚着床率显著低于优质组(χ^(2)=6.057,P<0.05),2组间TE B级的囊胚着床率比较差异无统计学意义(χ^(2)=0.001,P>0.05)。优质组中囊胚等级≤3BB、3BB~4BB、≥4BB的囊胚着床率分别为18.42%(14/76)、48.28%(14/29)、60.38%(32/53),优质组中囊胚等级3BB~4BB、≥4BB的囊胚着床率高于囊胚等级≤3BB(χ^(2)=9.567、23.957,P<0.05),≥4BB与3BB~4BB的囊胚着床率比较差异无统计学意义(χ^(2)=1.115,P>0.05)。非优质组中囊胚等级≤3BB、3BB~4BB、≥4BB的囊胚着床率分别为23.04%(53/230)、29.90%(29/97)、54.69%(70/128);非优质组中囊胚等级≥4BB的囊胚着床率显著高于囊胚等级3BB~4BB、≤3BB(χ^(2)=13.764、33.149,P<0.05),囊胚等级3BB~4BB与≤3BB的囊胚着床率比较差异无统计学意义(χ^(2)=1.706,P>0.05)。优质组与非优质组中囊胚等级≤3BB、3BB~4BB、≥4BB的囊胚着床率比较差异均无统计学意义(χ^(2)=0.714、3.355、0.493,P>0.05)。结论卵裂期非优质胚胎若形成囊胚,应优先选择≥4BB等级的囊胚行FET,以提高囊胚着床率。

Objective To compare the blastocyst implantation rate of high-quality embryos and non-high-quality embryos during cleavage stage underwent frozen-thawed blastocyst transfer(FET),and to explore the transfer value of blastocysts from non-high-quality embryos.Methods A total of 613 blastocysts at 5 days after fertilization(D_(5))underwent FET at the Reproductive and Genetic Center of the First Affiliated Hospital of Shandong University of Traditional Chinese Medicine from January,2018 to January,2022 were selected as the research objects.According to whether they were high-quality embryos at 3 days after fertilization(D_(3)),they were divided into high-quality group(n=158)and non-high-quality group(n=455).The blastocyst implantation rates of different endometrial preparation protocols,different expansion degrees of blastocyst cavity,different grades of inner cell mass(ICM),different grades of trophoblastic ectoderm(TE)and different grades of blastocyst were observed respectively.Results The blastocyst implantation rate of the high-quality group was 37.97%(60/158);the blastocyst implantation rates of natural cycle plan,alternative cycle plan,down regulation+alternative cycle plan and ovulation induction cycle plan were 38.30%(18/47),41.82%(23/55),36.67%(11/30)anD_(3)0.77%(8/26),respectively.There was no significant difference in the blastocyst implantation rate among the four endometrial preparation schemes in the high-quality group(χ^(2)=0.942,P>0.05).The blastocyst implantation rate in the non-high-quality group was 33.41%(152/455);the blastocyst implantation rates of natural cycle,alternative cycle plan,down-regulation+alternative cycle plan and ovulation induction cycle plan were 31.01%(40/129),32.43%(36/111),23.30%(7/30)anD_(3)7.30%(69/185),respectively.There was no significant difference in the blastocyst implantation rate among the four endometrial preparation schemes in the non-high-quality group(χ^(2)=3.008,P>0.05).There was no significant difference in the total blastocysts implantation rate between the high-quality group and the non-high-quality group,as well as the blastocyst implantation rate among natural cycle regimen,alternative cycle regimen,down-regulation+alternative cycle regimen,and ovulation induction cycle regimen(χ^(2)=1.082,0.829,1.414,1.270,0.419;P>0.05).The blastocyst implantation rate in gradE_(2),grade 3,grade 4 and grade 5 expansion of the blastocyst cavity in high-quality group were 6.25%(1/16),35.40%(25/71),46.38%(32/69)and 0.00%(0/2),respectively.The implantation rate in grade 3 and grade 4 expansion of the blastocyst cavity was significantly higher than that in gradE_(2)(χ^(2)=5.227,8.805;P<0.05);there was no significant difference in the blastocyst implantation rates of between grade 3 and grade 4 expansion of the blastocyst cavity(χ^(2)=1.807,P<0.05).The blastocyst implantation rates in gradE_(2),grade 3,grade 4 and grade 5 expansion of the blastocyst cavity in non-high-quality group were 40.43%(19/47),31.07%(64/206),34.03%(65/191)anD_(3)6.36%(4/11),respectively;there was no statistically significant difference in blastocyst implantation rate among different degrees of blastocyst cavity expansion in non-high-quality group(χ^(2)=1.624,P>0.05).The blastocyst implantation rate in gradE_(2)expansion of the blastocyst cavity in the non-high-quality group was significantly higher than that in the high-quality group(χ^(2)=6.434,P<0.05);there was no statistically significant difference in the blastocyst implantation rate in grades 3,4 anD_(5)expansion of the blastocyst cavity between the high-quality group and the non-high-quality group(χ^(2)=0.416,3.303,1.051;P>0.05).The blastocyst implantation rates in grade A,B and C of ICM in high-quality group were 16.67%(1/6),40.58%(56/138)and 21.43%(3/14),respectively;there was no statistically significant difference in blastocyst implantation rate among different grades of ICM in the high-quality group(χ^(2)=3.181,P>0.05).The blastocyst implantation rates in grade A,B and C of ICM in the non-high-quality group werE_(2)8.57%(2/7),34.07%(138/405)and 27.90%(12/43),respectively;there was no statistically significant difference in blastocyst implantation rate among different ICM grades in the non-high-quality group(χ^(2)=0.739,P>0.05).There was no statistically significant difference in blastocyst implantation rate in grade A,B and C of ICM between the high-quality group and the non-high-quality group(χ^(2)=0.258,1.897,0.229;P>0.05).The blastocyst implantation rates in grade A,B and C of TE in the high-quality group were 37.50%(6/16),36.28%(41/113)and 44.83%(13/29),respectively;there was no statistically significant difference in blastocyst implantation rate among different TE grades in the high-quality group(χ^(2)=0.713,P>0.05).The blastocyst implantation rates in grade A,B and C of TE in the non-high-quality group were 73.33%(11/15),36.16%(111/307)and 22.56%(30/133),respectively;the blastocyst implantation rate in grade A of TE in the non-high-quality group was significantly higher than that in grade B and C(χ^(2)=8.399,17.353;P<0.05);the blastocyst implantation rate in grade B of TE was significantly higher than that in grade C(χ^(2)=7.882,P<0.05).The blastocyst implantation rate in grade A of TE in the non-high-quality group was significantly higher than that in the high-quality group(χ^(2)=4.014,P<0.05),while the blastocyst implantation rate in grade C of TE in the non-high-quality group was significantly lower than that in the high-quality group(χ^(2)=6.057,P<0.05);there was no statistically significant difference in the blastocyst implantation rate in grade B of TE between the two groups(χ^(2)=0.001,P>0.05).The blastocyst implantation rates in blastocyst grade≤3BB,3BB-4BB and≥4BB in the high-quality group were 18.42%(14/76),48.28%(14/29)and 60.38%(32/53),respectively;the blastocyst implantation rate in blastocyst grade 3BB-4BB and≥4BB was significantly higher than that in grades≤3BB(χ^(2)=9.567,23.957;P<0.05);there was no statistically significant difference in the blastocyst implantation rates between blastocyst grade in grades≥4BB anD_(3)BB-4BB(χ^(2)=1.115,P>0.05).The blastocyst implantation rates in blastocyst grade≤3BB,3BB-4BB and≥4BB in the non-high-quality group werE_(2)3.04%(53/230),29.90%(29/97)anD_(5)4.69%(70/128),respectively;the blastocyst implantation rate in blastocyst grade≥4BB in the non high-quality group was significantly higher than that in grades 3BB-4BB and≤3BB(χ^(2)=13.764,33.149;P<0.05);there was no statistically significant difference in the blastocyst implantation rate between blastocyst grade 3BB-4BB and≤3BB(χ^(2)=1.706,P>0.05).There was no statistically significant difference in blastocyst implantation rates in blastocyst grade≤3BB,3BB-4BB,≥4BB between the high-quality group and the non-high-quality group(χ^(2)=0.714,3.355,0.493;P>0.05).Conclusion If the non-high-quality embryos at the cleavage stage form blastocysts,blastocysts of grade≥4BB should be preferentially selected for FET to improve the implantation rate of blastocyst.