囊胚培养与移植在不孕症患者中的应用

Application of blastocyst culture and transplantation in infertile patients

目的 探讨囊胚培养与移植在辅助生殖技术治疗过程中的应用价值,为改善不孕症患者妊娠结局提供一定的理论基础。方法 对2021年11月至2023年4月在本院生殖中心接受体外受精/卵胞浆内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection embryo transfer, IVF/ICSI-ET)治疗的631例新鲜周期患者的一般资料、促排卵效果、获卵数、受精卵数、胚胎发育情况及移植胚胎类型与临床妊娠结局比较进行分析,同时,收集本时间段内接受冻融周期即第3天(day 3,D3)卵裂期或第5/6天(day 5/day 6,D5/D6)囊胚期移植患者的妊娠结局进行分析比较。结果 IVF/ICSI-ET治疗患者中,D3卵裂期胚胎未养囊组、养囊成功组和养囊失败组的女方年龄[(34.85±0.37)vs (30.53±0.33)vs (32.43±0.47)]、促性腺激素(Gonadotropin, Gn)天数[(9.45±0.14)vs (9.82±0.10)vs (10.11±0.17)]、Gn总量[(2323.79±51.03)vs (2073.48±47.02)vs (2288.42±69.94)]、人绒毛膜促性腺激素(human chorionic gonadotropin, HCG)日促黄体素(luteinizing hormone, LH)[(4.34±0.23)vs (3.32±0.17) vs (3.95±0.31)]和雌二醇(estradiol, E2)[(1586.21±86.84) vs (4642.65±226.48) vs (2756.45±147.13)]水平及获卵(获卵数:[(5.52±0.26)vs (16.51±0.56)vs (10.80±0.54)]和早期胚胎发育情况(优质胚胎数:[(2.34±0.10) vs (7.51±0.31)vs (3.73±0.27)]均存在统计学差异,养囊成功组囊胚形成率41.68%。囊胚移植与D3卵裂期移植患者相比,HCG日激素水平、获卵数[(13.86±1.14)vs (8.37±0.28)]、成熟卵数[(12.29±1.06) vs (7.16±0.24)]及优质胚胎数[6.33±1.10)vs (3.68±0.14)]明显升高,但妊娠结局无统计学差异。冻融周期中囊胚移植、卵裂期移植及混合移植三组间胚胎种植率(45.59%vs 25.25%vs 34.85%)和临床妊娠率(55.93vs 39.01%vs 57.58%)均存在统计学差异,但流产率、多胎妊娠率和异位妊娠率无显著差异。结论 囊胚培养显著提高胚胎利用率,增加不孕症患者移植机率;囊胚移植有助于提高ART助孕患者的胚胎种植率和临床妊娠率。

Objective To explore the application value of blastocyst culture and transplantation in the treatment of assisted reproductive technology,and to provide a theoretical basis for improving the pregnancy outcome of infertility patients.Methods General data,ovulation promotion effect,number of eggs harvested,number of fertilized eggs,embryo development,type of transplanted embryos and clinical pregnancy outcomes of six hundred and thirty-one fresh cycle patients who received in vitro fertilization/intracytoplasmic sperm injection and embryo transfer treatment at the reproductive Center of our hospital from November 2021 to April 2023 were collected and compared.At the same time,the pregnancy outcomes of the patients who received the freeze-thaw cycle,namely the cleavage stage on day 3 or the blastocyst stage on day 5 or 6,were collected and analyzed.Results Among the patients treated with IVF/ICSI-ET,there were statistical differences in female age〔(34.85±0.37)vs(30.53±0.33)vs(32.43±0.47)〕,Gn days〔(9.45±0.14)vs(9.82±0.10)vs(10.11±0.17)〕,total amount of Gn〔(2323.79±51.03)vs(2073.48±47.02)vs(2288.42±69.94)〕,LH〔(4.34±0.23)vs(3.32±0.17)vs(3.95±0.31)〕and E2〔(1586.21±86.84)vs(4642.65±226.48)vs(2756.45±147.13)〕levels on HCG,egg acquisition(e.g.,number of eggs obtained:〔(5.52±0.26)vs(16.51±0.56)vs(10.80±0.54)〕and early embryonic development(e.g.,number of high-quality embryos:〔(2.34±0.10)vs(7.51±0.31)vs(3.73±0.27)〕in the non-blastocyst group,successful blastocyst group and failed blastocyst group at D3 cleavage stage.The blastocyst formation rate in the successful cysts group was 41.68%.The comparison between blastocyst transplantation and D3 cleavage stage transplantation showed that HCG daily hormone level,number of eggs obtained〔(13.86±1.14)vs(8.37±0.28)〕,number of mature eggs〔(12.29±1.06)vs(7.16±0.24)〕and number of high-quality embryos〔(6.33±1.10)vs(3.68±0.14)〕were significantly increased,but there was no statistical difference in pregnancy outcome.In the cryo-resuscitation cycle,the embryo implantation rate(45.59%vs 25.25 vs 34.85)and clinical pregnancy rate(55.93 vs 39.01 vs 57.58)among the three groups of blastocyst transfer,cleavage stage transfer and mixed transfer were statistically different.But there was no significant difference in abortion rate,multiple pregnancy rate and ectopic pregnancy rate.Conclusion Blastocyst culture can significantly improve the embryo utilization rate and increase the transplantation rate of infertility patients.Blastocyst transfer helps improve the rate of embryo implantation and clinical pregnancy in patients with ART-assisted pregnancy.