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.

Perinatal outcomes of frozen-thawed embryo transfer following blastocyst-stage embryo transfer compared to those of cleavage-stage embryo transfer:analysis of 9408 singleton newborns using propensity score analysis

Objective:Regarding frozen-thawed embryo transfer(FET),there is limited consensus on whether extending embryo culture from the cleavage stage to the blastocyst stage affects perinatal outcomes.This study aimed to compare perinatal outcomes of singletons between blastocyst-stage embryo transfer(BT)and cleavage-stage embryo transfer(CT)in FET.Methods:A total of 9408 FET cycles that met the inclusion criteria were included in this retrospective cohort study between 2019 and 2022.Blastocyst-stage embryo transfers were performed in the BT group,and cleavage-stage embryo transfers were performed in the CT group.Multivariate logistic regression analyses were performed,as well as propensity score matching(PSM)to adjust for confounders.Results:After PSM,a higher risk of pre-term birth(PTB;odds ratio[OR]:1.23,95%confidence interval[CI]:1.00-1.50,P=0.048)and being large for gestational age(LGA;OR:1.16,95%CI:1.00-1.35,P=0.050)was observed in the BT group compared to that in the CT group.After stratified PSM,in the subgroup under 35 years of age,only an increased risk of LGA was observed in the BT group compared to the CT group.Perinatal outcomes in the double-embryo transfer subgroup were similar to those in the unstratified group.However,in the subgroup beyond 35 years of age and the single embryo transfer subgroup,perinatal outcomes were not statistically different between the BT and CT groups(P>0.05).Conclusions:In FET,prolonged embryo culture to the blastocyst stage increased the risk of PTB and LGA in single fetuses.However,stratified analysis based on age and the number of transferred embryos yielded different results,necessitating further mechanistic studies.

囊胚发育速度和形态学参数与整倍体状态及妊娠结局的相关性

目的:研究胚胎植入前遗传学检测周期中,囊胚发育速度、囊胚扩张程度、内细胞团等级和滋养层细胞等级对其整倍体状态及整倍体胚胎移植后妊娠结局的影响。方法:回顾性分析2017年10月至2021年1月南京医科大学附属妇产医院生殖医学中心行胚胎植入前非整倍体遗传学检测(preimplantation genetic testing for aneuploidy,PGT-A)助孕的237个活检周期及127个复苏移植周期,分析胚胎发育速度和形态学特征与整倍体检测结果及妊娠结局的关系。结果:①纳入分析的237个活检周期中,共成功检测975枚囊胚,其中整倍体囊胚为479枚(49.13%),非整倍体囊胚为496枚(50.87%);②考虑校正因素后,第6、7天形成的囊胚较第5天整倍体率显著降低(OR=0.640,95%CI:0.493~0.830,P=0.001);囊胚内细胞团B级别整倍体率较A级别显著降低(OR=0.235,95%CI:0.123~0.449,P<0.001);囊胚滋养层C级别整倍体率较A级别显著降低(OR=0.360,95%CI:0.192~0.674,P=0.001);囊胚扩张程度与整倍体状态无关;③校正年龄前后,不同的囊胚形成时间、囊胚扩张程度、内细胞团级别、滋养层细胞等级之间临床妊娠率均未见差异。结论:PGT-A周期中,囊胚形成时间、内细胞团等级、滋养层细胞等级与整倍体状态显著相关,囊胚扩张程度与整倍体状态无关;囊胚发育速度、内细胞团等级、滋养层细胞等级及囊胚扩张程度均与整倍体胚胎复苏移植周期早期妊娠结局无相关性。

囊胚形态与整倍体率及单整倍体囊胚移植妊娠结局的关系

目的基于胚胎植入前非整倍体检测技术(PGT-A),评估囊胚形态学分级与染色体倍性之间的关系,并进一步评估囊胚形态学分级对于预测单整倍体囊胚移植(SEBT)妊娠结局的有效性。方法回顾性分析2016年9月至2019年4月期间在西北妇女儿童医院生殖中心完成囊胚期滋养外胚层细胞活检的PGT-A周期的临床资料,并随访活产情况至2021年3月。根据活检囊胚的Gardner形态学评分将活检囊胚分为优质囊胚组(394枚囊胚)和非优质囊胚组(1191枚囊胚)。比较两组的整倍体率及两组中单整倍体囊胚解冻移植后的妊娠结局。结果PGT-A共完成380个周期,共活检囊胚1585枚,其中优质囊胚394枚,非优质囊胚1191枚。两组的一般资料比较无显著性差异(P>0.05)。优质囊胚组的整倍体率显著高于非优质囊胚组(45.18%vs.37.28%,P<0.05),非整倍体率、嵌合体率及质控不合格率显著低于非优质囊胚组(分别为45.69%vs.49.62%、6.35%vs.8.56%及2.79%vs.4.53%,P<0.05)。两组共解冻移植单整倍体囊胚329个周期,优质囊胚组119个周期,非优质囊胚组210个周期,优质囊胚组的HCG阳性率(78.15%vs.73.81%)、临床妊娠率(76.47%vs.67.62%)及活产率(66.39%vs.57.14%)均略高于非优质囊胚组,流产率(10.08%vs.10.47%)略低于非优质囊胚组,但两组间尚无显著性差异(P>0.05)。结论囊胚形态学评分与囊胚的整倍体率有关,评分为优质的囊胚整倍体率更高。但进行单整倍体囊胚移植时,囊胚形态学评分并不影响妊娠结局。

不同内膜准备方案对整倍体单胚胎解冻移植妊娠结局的影响

目的探讨不同内膜准备方案对整倍体单胚胎解冻移植妊娠结局的影响。方法选取2015-11至2019-07行胚胎植入前遗传学非整倍体筛查(PGT-A)后行解冻移植的436例患者为研究对象。根据内膜准备方法不同分为两组:人工周期(HRT)组及自然周期(NC)组,比较两组患者的一般资料及妊娠结局。结果两组年龄、子宫内膜厚度及PGT-A适应证分布比较,差异无统计学意义。两组间的HCG阳性率、临床妊娠率、流产率、活产率比较差异无统计学意义。结论整倍体单胚胎解冻移植,人工周期和自然周期内膜准备方案并不影响妊娠结局。

整倍体单囊胚冷冻移植临床结局影响因素分析

目的筛选影响整倍体单囊胚移植成功率的关键因素。方法本项回顾性研究纳入2014年1月至2018年1月期间在上海集爱遗传与不育诊疗中心进行胚胎植入前遗传学检测(PGT)的冷冻整倍体单囊胚移植周期共956个的患者临床资料。按照移植结局,将患者分为妊娠组(n=509)及未妊娠组(n=447),比较两组间的临床资料,筛选出对移植妊娠率产生影响的关键因素;同时,进一步将妊娠组患者分为活产亚组和流产亚组,对比两亚组间的临床资料并利用logistic回归筛选对流产造成影响的显著性因素。结果妊娠组较未妊娠组,移植时子宫内膜厚度显著增厚[9(8,10)mm比8(8,10)mm](P=0.006);质量良好的囊胚相对于质量较差的囊胚临床妊娠率(59.2%比46.3%)及活产率(50.2%比37.7%)显著上升(P=0.001)。此外,活产亚组与流产亚组相比,囊胚发育时间为流产相关风险因素,OR值为0.536(95%CI=0.309~0.929)。结论在整倍体单囊胚移植冷冻周期中,较厚的子宫内膜、发育较快以及级别较高的囊胚是种植成功的关键因素。维持后期妊娠的过程中,发育较快的囊胚(第5日)活产率更高,流产率更低。