Pregnancy Outcomes for Day 5 Versus Day 6 Single Frozen-thawed Blastocyst Transfer with Different Qualities of Embryos: A Large Matched-cohort Study

Objective This study aimed to determine whether the day of blastocyst expansion affects pregnancy outcomes in frozen-thawed blastocyst transfer(FBT)cycles.Methods A retrospective match-cohort study was conducted.Patients who underwent blastocyst transfer in frozen-thawed cycles at day 5 or 6 were matched for potential confounding factors.A total of 2207 matched pairs of FBT cycles were included from January 2016 to December 2019 in our Reproductive Medicine Center.Results The clinical pregnancy rate(CPR)and live birth rate(LBR)were significantly increased in day 5 blastocyst transfers when compared to day 6 blastocyst transfers,in terms of the same embryo quality.For FBT cycles with good-quality embryo,the CPR at day 5 and 6 was 61.30%and 57.56%,respectively(P=0.045),and the LBR was 44.79%and 36.16%,respectively(P<0.001).For FBT cycles with poor-quality embryo,the CPR at day 5 and 6 was 48.61%and 40.89%,respectively(P=0.006),and the LBR was 31.71%and 25.74%,respectively(P=0.019).The CPR for FBT cycles with good-quality embryo was statistically higher at day 6 than that at day 5 with poor-quality embryo transferred(57.56%vs.48.61%,P=0.001).Maternal age,anti-Müllerian hormone(AMH),endometrial thickness,embryo quality,and the day of blastocyst expansion were independently correlated with the CPR and LBR.The FBT cycles at day 5 had significantly higher CPR(adjusted odds ratio[OR]=1.246,95%confidence intervals[CI]:1.097–1.415,P=0.001)and LBR(adjusted OR=1.435,95%CI:1.258–1.637,P<0.001)than those at day 6.Conclusion The embryo quality is the primary indicator for FBT cycles.Day 5 blastocysts should be preferred when the quality of embryo at day 5 is the same as that at day 6.

Predictive Value of Initial Serum Human Chorionic Gonadotropin Levels for Pregnancies after Single Fresh and Frozen Blastocyst Transfer

As one of the earliest markers for predicting pregnancy outcomes, human chorionic gonadotropin(h CG) values have been inconclusive on reliability of the prediction after frozen and fresh embryo transfer(ET). In this retrospective study, patients with positive h CG(day 12 after transfer) were included to examine the h CG levels and their predictive value for pregnancy outcomes following 214 fresh and 1513 vitrified-warmed single-blastocyst transfer cycles. For patients who got clinical pregnancy, the mean initial h CG value was significantly higher after frozen cycles than fresh cycles, and the similar result was demonstrated for patients with live births(LB). The difference in h CG value existed even after adjusting for the potential covariates. The area under curves(AUC) and threshold values calculated by receiver operator characteristic curves were 0.944 and 213.05 m IU/m L for clinical pregnancy after fresh ET, 0.894 and 399.50 m IU/m L for clinical pregnancy after frozen ET, 0.812 and 222.86 m IU/m L for LB after fresh ET, and 0.808 and 410.80 m IU/mL for LB after frozen ET with acceptable sensitivity and specificity, respectively. In conclusion, single frozen blastocyst transfer leads to higher initial h CG values than single fresh blastocyst transfer, and the initial h CG level is a reliable predictive factor for predicting IVF outcomes.

Sperm DNA fragmentation does not affect the clinical outcomes in the cumulative transfers of an ICSI cycle along with blastocyst transfers in couples with normozoospermic male patients

Objective:To know whether sperm DNA fragmentation(SDF)affects the clinical outcomes in the cumulative transfers of an intracytoplasmic sperm injection(ICSI)cycle along with blastocyst transfers in couples with normozoospermic males.Methods:The study included 252 couples who underwent their first ICSI cycles along with blastocyst transfer and whose male partner semen samples were normozoospermic according to the World Health Organization 2010 criteria.All the couples were classified into two groups based on the SDF:the low SDF group(SDF≤30%,n=162)and the high SDF group(SDF>30%,n=90).Clinical as well as laboratory outcomes were correlated between the two groups.Sperm DNA fragmentation was assessed on the post-wash semen samples by acridine orange test.The main outcome measures were the live birth rate and miscarriage rate.Results:A significant decrease in the live birth rates was observed in the high SDF group compared to the low SDF group in fresh embryo transfer cycles(P<0.05).However,no significant difference was observed in the clinical outcomes either in the frozen embryo transfer cycles or in the overall cumulative transfer cycles(P>0.05).No significant difference was observed in the laboratory outcomes between the two SDF groups.A remarkable decrease in sperm motility was observed in the high SDF group compared to the low SDF group(P<0.05).Conclusions:Sperm DNA fragmentation does not affect the clinical outcomes in the cumulative transfers of an ICSI cycle along with blastocyst transfers in couples with normozoospermic males.

Comparison of Pregnancy Outcomes of High-Quality D5- and D6-Blastocyst Transfer in Hormone-Replacement Frozen-Thawed Cycles

This study aimed to assess pregnancy outcomes after high-quality D5- and D6-blastocyst transfer in frozen cycles of in vitro fertilization and embryo transfer and to further evaluate whether there was a difference in blastocyst development potentials with different developmental speeds and in pregnancy outcomes. A retrospective analysis was conducted to analyze 247 frozen cycles in our center from September 2015 to July 2017, which were divided into two groups: a D5-FET group with 193 cycles of D5-blastocyst transfer, and a D6-FET group with 54 cycles of D6-blastocyst transfer. Hormone replacement method was utilized to prepare frozen-cycle endometria. Pregnancy outcomes were analyzed and compared between these two groups. The mean ages of the two groups were 31.45 ± 4.43 years and 31.98 ± 4.84 years, respectively, with no statistically significant differences (P > 0.05). The difference in the endometrial thickness during transfer was also not statistically significant. The implantation rate in the D5-FET group was 60.13%, significantly higher than that in the D6-FET group (31.58%, P P < 0.05). No statistically significant differences were found in the abortion rate and ectopic pregnancy rate between the two groups. The implantation, biochemical pregnancy, and clinical pregnancy rates of the blastocyst D5 were all superior to those of the blastocyst D6. In clinics, therefore, D5-blastocyst transfer could be prioritized for embryo transfer.

Frozen Blastocyst Transfer during <i>in Vitro</i>Fertilization/Intracytoplasmic Sperm Injection Cycle Lowers the Rate of Ectopic Pregnancy

This study aimed to determine whether frozen blastocyst transfer can lower the incidence rate of ectopic pregnancy. A total of 1577 in vitro fertilization/ intra-cytoplasmic cycles were analyzed, including 757 fresh D3-ET cycles, 429 frozen D3-ET cycles, and 391 frozen D5-ET cycles. The differences of ages, the proportion of IVF cycles, the proportion of primary infertility, and the proportion of tubal factor between three groups were not significant. The clinical pregnancy rate in Frozen D5-ET Group was 62.15%, which was significantly higher than other two groups (46.10%;38.93%;P < 0.05). The miscarriage rates of three groups were similar. The ectopic pregnancy rate in Frozen D5-ET Group was 0.41%, which was significantly lower than that in Frozen D3-ET Group (2.99%, P < 0.05) and slightly lower than that in Fresh D3-ET Group (2.29%, P = 0.089). Results from this study show that the transfer of frozen D5 blastocysts can significantly decrease the incidence rate of ectopic pregnancy.

Improvement of Live Birth Rate Following Frozen-Thawed Blastocyst Transfer by Combination of Prednisolone Administration and Stimulation of Endometrium Embryo Transfer

The endometrial condition is a significant factor for successful pregnancy. To regulate endometrial function in fertility treatment, prednisolone (PSL) is administered for suppression of increased natural killer cells and stimulation of endometrium embryo transfer (SEET) to enhance communication between embryo and maternal tissues. We attempted to improve the endometrial condition by PSL administration and SEET during frozen–thawed blastocyst transfer (FBT). Patients took PSL (5 mg) 3 times daily for 3 days after ovulation during the FBT cycle. To analyse effects of PSL combined with SEET, we determined rates of chemical pregnancy, clinical pregnancy, foetal heart movement (FHM) and live birth. Rates of chemical pregnancy, clinical pregnancy and FHM were significantly higher in the PSL(+)/SEET(+) (57.7%, 50.0% and 46.2%, respectively) and PSL(+)/SEET(-) (53.3%, 46.7% and 46.7%, respectively) groups than in the PSL(-)/SEET(+) (30.3%, 18.2% and 18.2%, respectively) and PSL(-)/SEET(-) (22.4%, 22.4% and 18.4%;P = 0.0043, 0.0081 and 0.0055, respectively) groups. The live birth rate was significantly higher in the PSL(+)/SEET(+) group than in the PSL(+)/SEET(-), PSL(-)/SEET(+) and PSL(-)/SEET(-) groups (42.3%, 26.7%, 18.2% and 12.2%, respectively;P = 0.0237). PSL combined with SEET may be a useful adjunct to assisted reproductive technology in women who repeatedly fail to conceive by infertility treatment.

Elective single blastocyst transfer is more suitable for normal responders than for high responders

Background Embryo quality and receptivity of the endometrium are two factors that determine the results of in vitro fertilization/intra-cytoplasmic sperm injection-embryo transfer （IVF/ICSI-ET）. There is no consensus of the optimal transfer strategy for normal responders or high responders. The current study aimed to find the optimal transfer strategy for different subgroups of patients. Methods From April 2010 to December 2010, patients who meet the following criteria were included in this study; primary infertility, female age 〈35 years, FSH level on female cycle day 2-3 〈12 mlU/ml, at least six good quality embryos available on day three.The clinical outcomes using different transfer strategies between normal responders and high responders were reviewed and compared. Results For the normal responders, the clinical pregnancy rate of day three double-embryo transfer （DET） was comparable to that of day five elective single blastocyst transfer （eSBT）, 64.04% vs. 60.33% （P〉0.05）. For the high responders, the clinical pregnancy rate of day five eSBT was significantly lower than that of day three DET, 43.35% vs. 57.21% （P〈0.05）. For the high responders, the rates of clinical pregnancy and implantation in frozen-thawed embryo transfer （FET） cycles were notably higher than in eSBT cycles （64.56% vs. 43.35% and 62.11% vs. 43.35% respectively） （P〈0.05）. Conclusions For normal responders, eSBT might be an applicabte strategy to reduce multiple pregnancy rates while maintaining acceptable overall pregnancy rates. And in order to reduce multiple pregnancies and increase the chance of pregnancy of high responders, FET may be a preferable strategy.

Association between estradiol levels and clinical outcomes of IVF cycles with single blastocyst embryo transfer

Objective:To determine the correlation of different serum estradiol levels on the trigger day with the clinical and laboratory outcomes of in-vitro fertilization(IVF)cycles comprising a single fresh top-quality blastocyst transfer.Methods:This was a retrospective observational study performed in Morula IVF Clinic Jakarta.Five hundred forty-two women were recruited and grouped according to their serum estradiol levels on the trigger day of follicular maturation as follows:<2000 pg/mL,2000-2999 pg/mL,3000-3999 pg/mL,and≥4000 pg/mL.Clinical pregnancy and miscarriage rates were evaluated as the primary outcomes and embryology laboratory results as the secondary outcomes which consisted of the number of retrieved,mature,and fertilized oocytes,the total sum of derived embryos,and top-quality embryos at cleavage and blastocyst stage.Results:Clinical pregnancy and miscarriage rates did not differ among the groups(P>0.05).Nonetheless,the study demonstrated a positive correlation of the serum estradiol levels with the overall laboratory outcomes including the number of retrieved,mature,and fertilized oocytes,the total sum of derived embryos,and top-quality embryos at cleavage and blastocyst stage(P<0.001).The subject group with estradiol level of≥4000 pg/mL was superior to the other groups in its respective median number of retrieved,mature,fertilized oocytes,total derived embryos,and top-quality cleavage-and blastocyst-stage embryos.Conclusions:Although an apparent positive correlation is observed between estradiol levels and laboratory outcomes,serum estradiol level on hCG trigger day is not associated with the clinical outcomes of IVF.

Overall Blastocyst Quality, Trophectoderm Grade, and Inner Cell Mass Grade Predict Pregnancy Outcome in Euploid Blastocyst Transfer Cycles

Background： Despite recent advances that have improved the pregnancy success rates that can be achieved via in vitro fertilization （IVF） therapy, it is not yet clear which blastocyst morphological paralneters best predict the outcomes of single blastocyst transfer. In addition. most of the previous studies did not exclude the effect of embryo aneuploidy on blastocysts transfer. Thus, the present study investigated the predictive value of various parameters on the pregnancy outcomes achieved via the transfer of frozcn euploid blastocysts. Methods： The study retrospectively analyzed 914 single euploid blastocyst transfer cycles that were performed at the Peking U laivcrsity Third Hospital Reproductive Medical Center between June 2011 and May 2016. The expansion, trophectoderm （TE）. and inner cell mass （ICM） quality of the blastocysts were assessed based on blastocyst parameters, and used to differentiate between ＂excellent＂, ＂good＂, ＂average＂, and ＂poor＂-quality embryos. The relationship between these embryo grades and the achieved pregnancy outcomes was then analyzed via the Chi-square and logistic regression tests. Results： For embryo grades of excellent, good, average and poor, the clinical pregnancy rates were 65.0%. 50.3%, 50.3% and 33.3%. respectively; and the live-birth rates were 50.0%, 49.7%, 42.3% and 25.0%, respectively. Both the clinical pregnancy ratc （x2= 21.28. P = 0.001） and live-birth rate （x2 = 13.50, P 〈 0.001） increased with the overall blastocyst grade. Both rates were significanlly higher after the transfer era blastocyst that exhibited either an A-grade or B-grade TE, and similarly, an A-grade ICM. than after the transfer el a blastocyst that exhibited a C-grade TE and/or ICM. The degree of blastocysl expansion had no apparent effect on the clinical pregnancy or live-birth rate. All odds ratio were adjusted for patient age, body mass index, length （years） of infertility history, and infertility type. Conclusions： A higher overall euploid blastocyst quality is shown to correlate most strongly with optimal pregnancy outcomes. The study thus supports the use of the described TE and ICM morphological grades to augment current embryo selection criteria.

Effect of Adding a Delayed Blastocyst to a Good Quality One during Embryo Transfer on ICSI Cycle Outcomes

Objectives: Study the effect of adding a delayed blastocyst to a transferred good quality one on ICSI cycle outcomes. Study design: Prospective cohort study. Participants/materials, setting, methods: 90 infertile patients aged from 20 - 35 years due to mild male factor, unexplained infertility or tubal factor. Patients with PCOS, endometriosis, RIF, poor responder and azoospermia were excluded. Setting: Duration 6 months from October 2019 to April 2020 in a private IVF center in Egypt. 30 cases were subjected to elective single embryo transfer and the other 60 with two embryo transfers, one good quality and another poor quality blastocyst. Results: (clinical pregnancy rate) was comparable between the two groups, being 47.7% and 36.7% in SET and DET groups respectively (p = 0.361). Miscarriage and ectopic pregnancy rate were observed in 10% of the cases pregnant after SET (group I) and in only 6.7% of the cases pregnant after DET (group II) denoting no significant statistical difference between the two groups. The highest incidence was missed miscarriages in the two groups and ectopic pregnancy was observed only in one case in group II (DET). Twin pregnancy occurred in 22% of pregnant females in the second group. Late pregnancy complications in the form of preterm labour, premature rupture of membrane and preeclampsia occurred mainly in pregnant females in the second group 18%. Conclusion: Neither adding a delayed blastocyst negatively affected the good one nor affected the live birth rate but increased multiple pregnancy rates.

冻融优质单囊胚移植失败后重复周期胚胎移植策略的探讨

目的探讨冻融优质单囊胚移植失败后重复周期的胚胎移植策略。方法回顾性分析2018年7月至2022年10月在我中心进行冻融优质单囊胚移植后重复周期治疗患者的临床资料,共887个周期。根据患者年龄不同分为<35岁组(568个周期)和≥35岁组(319个周期),每组又根据胚胎移植情况分为5个亚组:单优囊组(移植冻融优质单囊胚)、双优囊组(移植冻融优质双囊胚)、优+非优囊组(移植冻融优质+非优质双囊胚)、双非优囊组(移植冻融非优质双囊胚)及双优卵裂组(移植冻融双卵裂胚)。比较各组患者的基础资料及妊娠结局。结果<35岁组中单优囊组、双优囊组、优+非优囊组、双非优囊组及双优卵裂组患者的年龄、基础FSH、移植日内膜厚度等基础资料比较均无显著性差异(P>0.05);单优囊组的临床妊娠率显著低于其他4组(60.41%vs.77.08%、72.73%、69.74%、70.83%,P<0.05),活产率亦显著低于其他4组(49.80%vs.68.75%、61.82%、59.21%、61.11%,P<0.05),双优卵裂组的多胎妊娠率显著高于单优囊组(38.24%vs.1.35%,P<0.05),但显著低于双优囊组(67.57%)、优+非优囊组(57.50%)及双非优囊组(56.60%)(P<0.05)。≥35岁组中各亚组的基础资料亦无显著性差异(P>0.05);各亚组间的临床妊娠率、活产率、流产率比较均无显著性差异(P>0.05),但单优囊组的多胎妊娠率显著低于其他4组(0.00%vs.33.33%、29.17%、20.59%、15.00%,P<0.05)。结论对于接受冻融优质单囊胚移植后行重复周期治疗的不孕患者,冻融胚胎移植策略的选择需要综合权衡。年龄≥35岁的患者,5种胚胎移植策略获得的临床结局相近,可以根据患者实际情况进行选择;而年龄<35岁的患者,在没有条件进行冻融优质单囊胚移植时,也可以考虑冻融优质双卵裂胚移植策略,但其后续多胎妊娠率风险较高,仍需要关注。

多囊卵巢综合征患者冻融胚胎移植周期妊娠结局的影响因素分析

目的探讨多囊卵巢综合征(PCOS)患者冻融胚胎移植(FET)周期妊娠结局的影响因素。方法回顾性分析882个FET周期PCOS患者的资料,根据患者的妊娠结局分为未着床组(A组)、流产组(B1组)和活产组(B2组)。比较这三组患者的临床资料和实验室指标,并使用有序Logistic回归分析冻融胚胎移植后妊娠结局的影响因素。再按照获取优质囊胚数的百分位数(0~3、4~6、7~10、≥11个)将患者分为C1、C2、C3、C4组,比较不同优质囊胚数组患者的临床资料及实验室相关指标。结果882个PCOS患者移植周期的临床妊娠率71.09%(627/882),活产率61.68%(544/882),流产率13.24%(83/627)。单因素分析显示,在A、B1和B2这三组的比较中,体质量指数(BMI)、不孕类型、注射人绒毛膜促性腺激素(hCG)日雌二醇(E_(2))水平、获卵数和优质囊胚数之间存在显著差异(P<0.05)。对五项差异指标进行进一步多元Logistic回归分析显示,BMI(OR=1.046,95%CI:1.001~1.093,P=0.044)和有既往妊娠史(OR=1.417,95%CI:1.030~1.950,P=0.032)是PCOS患者成功妊娠的独立危险因素。A组与B2组比较:OR=0.920,95%CI:0.880~0.962,P=0.000;B1组与B2组比较:OR=0.923,95%CI:0.862~0.988,P=0.022;而优质囊胚数增多则是妊娠成功的独立保护因素。在优质囊胚数C1-C4这四组之间比较中,与其他三组相比,C4组的促性腺激素(Gn)总量最低,获卵数最多(P<0.05)。C4组的BMI、促卵泡生成素(FSH)和极低密度脂蛋白(vLDL)水平较C1组低,黄体生成素与促卵泡生成素(LH/FSH)比值比C1组高(P<0.05)。C4组与C3组相比,空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR)值较低,与C2和C3组相比,高密度脂蛋白胆固醇(HDL-C)和载脂蛋白A1(ApoA1)水平较高(P<0.05)。结论BMI、既往妊娠史和优质囊胚数是预测PCOS患者FET周期妊娠结局的独立因素。优质囊胚数更多的患者在FET周期中具有更高的临床妊娠率。

卵裂期胚胎发育速度对体外受精-胚胎移植临床结局的影响

目的 探讨不同发育速度的卵裂期胚胎对后续囊胚培养及移植后结局的影响。方法 回顾性分析2020年1月至2023年7月于该院生殖中心行体外受精-胚胎移植/卵胞浆内单精子注射助孕的患者资料,根据第3天胚胎卵裂球数目分为6~10个细胞组及11~16个细胞组。其中6~10个细胞组又分为6个细胞组、7个细胞组、8个细胞组、9个细胞组和10个细胞组;11~16个细胞组又分为11~12个细胞组、13~14个细胞组和15~16个细胞组。比较各组的囊胚培养情况和移植后的临床结局。结果 11~16个细胞组的非二倍卵裂率和卵裂球碎裂率明显高于6~10个细胞组,差异有统计学意义(P<0.05)。6~10个细胞组的囊胚形成率和优质囊胚率均明显低于11~16个细胞组,差异均有统计学意义(P<0.05);2组临床妊娠率、胚胎种植率、流产率、活产率和抱婴回家率比较,差异均无统计学意义(P>0.05)。在6~10个细胞各亚组中,6个细胞组的囊胚形成率明显低于其他各组,差异有统计学意义(P<0.05);7个细胞组的囊胚形成率明显低于8个细胞组、9个细胞组、10个细胞组,差异有统计学意义(P<0.05);6个细胞组和7个细胞组的优质囊胚率明显低于8个细胞组、9个细胞组、10个细胞组,差异有统计学意义(P<0.05);各组间的临床妊娠率、胚胎种植率、早期流产率、活产率和抱婴回家率比较,差异无统计学意义(P>0.05)。在11~16个细胞各亚组中,3组的囊胚形成率、优质囊胚率、临床妊娠率、胚胎种植率、流产率、活产率和抱婴回家率比较,差异均无统计学意义(P>0.05)。结论 发育速度较快的11~16个细胞胚胎可形成高质量囊胚,移植后可获得较好的临床结局。

囊胚培养与移植在不孕症患者中的应用

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。

卵裂期胚胎复苏后培养至囊胚移植对RIF患者妊娠结局的影响

目的探讨对于反复种植失败(RIF)的患者,解冻卵裂期胚胎继续培养至囊胚移植能否改善患者的妊娠结局。方法回顾性分析2015年1月至2022年12月在我院生殖医学科接受冻融胚胎移植(FET)治疗的587例RIF患者的临床资料,根据不同的胚胎移植方案分为3组:解冻卵裂期胚胎继续培养至囊胚移植的为A组(n=45),解冻卵裂期胚胎移植的为B组(n=299),解冻囊胚移植的为C组(n=243);同时,将C组按解冻的囊胚发育时期分为移植第5天囊胚组(C-D5组,n=183)和移植第6天囊胚组(C-D6组,n=60),比较各组HCG阳性率、种植率、临床妊娠率、流产率、活产率等妊娠结局以及平均孕周和新生儿出生体重。结果选择解冻卵裂期胚胎继续培养至囊胚移植方案的患者初始有56例,11例患者(19.64%)因囊胚培养失败而取消周期。妊娠结局比较中,与B组相比,A组和C组的HCG阳性率(62.22%、57.61%vs.45.15%)、种植率(49.12%、44.48%vs.33.07%)及活产率(48.89%、44.03%vs.33.78%)均显著升高(P<0.05),3组间的流产率无显著差异(P>0.05);与C-D6组相比,A组和C-D5组的种植率(49.12%、48.70%vs.29.33%)、临床妊娠率(57.78%、56.28%vs.38.33%)及活产率(48.89%、49.18%vs.28.33%)均显著升高(P<0.05)。新生儿出生情况比较,A组的新生儿出生体重显著高于B组和C组(P<0.05),3组间的平均孕周无显著差异(P>0.05);A组和C-D6组新生儿出生体重显著高于C-D5组(P<0.05)。结论解冻卵裂期胚胎继续培养至囊胚移植可能在一定程度上能够改善RIF患者的妊娠结局。在FET周期中,若患者有D5囊胚冻存,建议优先解冻移植;若无冻存D5囊胚,可以尝试解冻卵裂期胚胎继续培养囊胚后移植,以获得较好的临床结局。

大于38岁女性冻融移植周期单囊胚与双囊胚移植妊娠结局比较

目的探讨大于38岁女性在冻融囊胚移植周期中移植不同囊胚数目和质量时的妊娠结局。方法纳入2017年1月至2021年12月在广东省生殖医院生殖中心接受冻融囊胚移植且移植年龄大于38岁的249例女性为研究对象,对其249个移植周期的临床资料进行回顾性分析。根据不同的囊胚移植数目和质量分为5组:移植单个优质囊胚组(A组,94个周期),移植单个非优质囊胚组(B组,103个周期),移植双优质囊胚组(C组,10个周期),移植单个优质囊胚+单个非优质囊胚组(D组,18个周期)和移植双非优质囊胚组(E组,24个周期)。比较分析不同囊胚移植数目和质量组间的一般资料、胚胎实验室指标及妊娠结局。结果各组患者的一般情况比较发现,D组的取卵年龄显著大于A组(P<0.05),C组的基础FSH(bFSH)显著低于A组,E组的bFSH显著低于B组(P均<0.05);各组间移植年龄、窦卵泡数、体质量指数(BMI)、促性腺激素(Gn)用量、移植日内膜厚度、人工周期方案比例均无显著性差异(P>0.05)。E组的获卵数显著大于B组[(12.67±4.98)vs.(10.69±4.08),P<0.05];各组间D3可用胚胎数、优胚数、囊胚培养数、囊胚形成数、囊胚冷冻数比较均无显著性差异(P>0.05)。A组与C组比较,多胎率显著降低(6.00%vs.33.30%,P<0.05),组间着床率、临床妊娠率、流产率、活产率及早产率比较均无显著性差异(P>0.05);A组与D组比较,着床率显著增高(53.20%vs.27.80%,P<0.05),活产率相似(35.10%vs.33.30%,P>0.05);A组与E组比较,多胎率显著降低(6.00%vs.33.30%,P<0.05),组间着床率、临床妊娠率、流产率、早产率、活产率比较均无显著性差异(P>0.05);B组与E组比较,临床妊娠率、多胎率显著降低(P<0.05),组间着床率、流产率、活产率及早产率比较均无显著性差异(P>0.05)。结论大于38岁高龄女性在冻融囊胚移植周期中若有优质囊胚,建议优先移植单个优质囊胚;若没有优质囊胚,也应考虑移植单个囊胚。

玻璃化冷冻囊胚复苏后不同体外培养时间对临床妊娠结局的影响

目的 探讨玻璃化冷冻的扩张期囊胚解冻复苏后不同的培养时间对临床妊娠结局的影响。方法 回顾性分析我院2021年1月1日至2022年12月31日期间通过玻璃化冷冻的D5及D6囊胚移植周期临床资料,共1 867周期。根据囊胚复苏后体外培养时间将其分为A组(<2 h,n=958)和B组(2~4 h,n=909),再根据移植囊胚的数目分为两个亚组,移植1枚囊胚定义为A1组(n=843)和B1组(n=798),移植2枚囊胚定义为A2组(n=115)和B2组(n=111)。比较各组HCG阳性率、临床妊娠率、胚胎着床率、多胎率、早期流产率及最终活产率之间的差异。结果 患者的平均年龄、不孕年限、内膜厚度以及基础激素水平等在A1和B1组、A2和B2组之间均无显著差异(P>0.05)。妊娠结局方面,移植1枚囊胚的两组(A1和B1)间HCG阳性率、临床妊娠率、胚胎着床率、多胎率、早期流产率、异位妊娠率和活产率比较均无显著差异(P>0.05);移植2枚囊胚的两组(A2和B2)比较,A2组的HCG阳性率显著高于B2组(91.30%vs. 79.28%,P<0.05),A2组临床妊娠率(81.74%vs. 71.17%)、胚胎着床率(61.30%vs. 54.05%)、活产率(67.83%vs. 63.06%)也均高于B2组,但差异无统计学意义(P>0.05)。Logistic分析结果表明,移植2枚冻融囊胚时体外培养时间<2 h是HCG阳性率的独立影响因素[OR=2.210,95%CI(1.028,4.752),P=0.042]。结论 双囊胚移植周期解冻后应尽量在2 h内移植,以便获得更好临床结局;单囊胚移植者解冻后在4 h内移植临床妊娠结局并无明显差异。

复苏周期单囊胚移植临床结局影响因素修正Poisson分析:一项回顾性队列研究

目的分析复苏周期单囊胚移植临床结局的影响因素。方法回顾性分析2017年1月至2022年12月在湖州市妇幼保健院生殖中心接受复苏周期单囊胚移植的不孕患者的618个复苏周期,根据囊胚移植后是否临床妊娠分为妊娠组300个和未妊娠组318个,根据囊胚移植后是否活产分为活产组241个和未活产组377个。采用单因素和修正Poisson分析影响复苏周期单囊胚移植临床妊娠、活产的因素。结果妊娠组和未妊娠组患者年龄、双卵巢窦卵泡数(AFC)、血清抗米勒管激素(AMH)水平、移植周期数、囊胚天数、胚胎类型比较差异均有统计学意义(均P<0.05)。修正Poisson分析显示患者年龄、移植周期数、囊胚天数均是影响临床妊娠的重要因素(均P<0.05)。活产组和未活产组患者年龄、AFC、AMH、BMI、移植周期数、囊胚天数、胚胎类型比较差异均有统计学意义(均P<0.05)。修正Poisson分析显示患者年龄、囊胚天数是影响活产的重要因素(均P<0.05)。结论患者年龄、囊胚发育天数是影响复苏周期单囊胚移植临床妊娠和活产的重要因素。

冻胚移植发生复合妊娠的影响因素分析

目的 探讨影响冻胚移植(frozen embryo transfer, FET)发生复合妊娠(heterotopic pregnancy, HP)的相关性因素。方法 回顾性分析2016-01/2022-06月在作者医院生殖医学科行FET术后妊娠178例患者的临床资料,根据妊娠部位分为HP组(n=17)、异位妊娠组(n=76)、宫内妊娠组(n=85)。结果 3组患者因输卵管因素造成不孕的比例比较差异有统计学意义(P<0.05),异位妊娠组患者因输卵管因素造成不孕的比例高于宫内妊娠组(P<0.05)。HP组和异位妊娠组既往有输卵管手术史的患者占比明显高于宫内妊娠组(P<0.05)。3组FET患者移植胚胎个数差异有统计学意义(P<0.05),异位妊娠组中单胚胎移植率明显低于宫内妊娠组(P<0.05)。HP组和FET异位妊娠组患者卵裂期胚胎移植率明显高于宫内妊娠组,囊胚移植率明显低于宫内妊娠组(P均<0.05)。进一步Logistic回归分析发现,相对于FET宫内妊娠,输卵管手术史会增加FET发生HP的风险(OR=5.250,95%CI:1.467~18.788),移植胚胎个数的增多会增加FET发生HP的风险(OR=14.336,95%CI:1.381~148.849),而移植囊胚会降低FET发生HP的风险(OR=0.164,95%CI:0.027~0.996)。结论 输卵管手术史是FET发生HP的高危因素,而通过减少移植胚胎个数和囊胚移植可降低HP的发生率。

新鲜周期第5天囊胚形成的影响因素分析及列线图模型的构建与验证

目的 探究新鲜周期第5天(D5)囊胚形成的影响因素,构建并验证列线图预测模型。方法 回顾性分析2019年1月至2022年3月在焦作市妇幼保健院生殖医学科接受体外受精治疗的1 384例患者的数据资料,按照7∶3的比例随机将患者分为训练集(952例)和验证集(432例)。通过单因素分析及多因素logistic回归分析筛选D5囊胚形成的独立影响因素,基于独立影响因素的回归系数,使用R语言软件构建D5囊胚形成的列线图预测模型,通过受试者工作特征(ROC)曲线的曲线下面积(AUC)及Hosmer-Lemeshow检验评价模型的区分度与校准度。结果 多因素logistic回归分析显示,女方年龄、抗苗勒氏管激素、受精方式、第3天(D3)优质胚胎率、行囊胚培养的D3胚胎数为新鲜周期D5囊胚形成的独立影响因素,训练集和验证集ROC曲线的AUC分别为0.828(95%CI:0.802~0.853)与0.818(95%CI:0.779~0.857)。Hosmer-Lemeshow拟合优度检验结果显示,模型的预测概率与实际观测概率比较,差异无统计学意义。结论 新鲜周期D5囊胚形成的列线图预测模型可为临床医生提供参考,有助于在临床工作中更好地实施单囊胚移植。