摘要
目的分析冷冻胚胎复苏移植周期移植发育D5/D6的新鲜囊胚和冻融囊胚的临床结局,探讨不同发育时期囊胚的发育潜能,为进一步改进胚胎冷冻移植方案提供依据。方法回顾性分析因输卵管因素或男方因素行IVF/ICSI治疗后复苏周期行胚胎解冻培养新鲜囊胚移植和冻融囊胚移植患者的临床资料,根据囊胚形成和发育时间不同分为D5鲜囊胚组,D6鲜囊胚组,D5冻融囊胚组和D6冻融囊胚组。自然周期或雌激素替代周期准备子宫内膜,厚度达到8 mm以上后予黄体酮转化(D0),内膜转化第3天解冻复苏胚胎行囊胚培养,第5天移植发育至D5的囊胚,第6天移植发育D6囊胚;冻融囊胚在内膜转化第5天复苏,2 h后移植,分析比较各组间的临床结局。结果冷冻胚胎复苏后囊胚培养,D5鲜囊胚移植的胚胎种植率(48.57%)显著高于D6鲜囊胚(26.67%),差异有统计学意义(P<0.05);临床妊娠率(68.52%)也明显高于D6鲜囊胚移植(46.67%),但差异无统计学意义(P>0.05)。D5冻融囊胚的临床妊娠率(73.72%)和胚胎种植率(55.47%)均显著高于D6冻融囊胚组(47.89%和32.39%),差异有统计学意义(P<0.01);D5/D6鲜囊胚分别与D5/D6冻融囊胚相比较,两组间临床妊娠率、胚胎着床率、流产率及活产率差异均无统计学意义(P>0.05)。结论无论是冻融胚胎解冻养囊胚还是冻融囊胚复苏移植,D5囊胚移植相较于D6囊胚移植更有利于胚胎着床,获得更好的临床妊娠结局。新鲜周期移植后多余胚胎可行囊胚培养后冷冻保存,反复胚胎移植失败者可考虑将冻融胚胎行囊胚培养后移植,既提高胚胎利用率又有利于改善临床妊娠结局。
Objective To analyze the clinical outcomes of Day 5 / Day 6 fresh blastocysts and frozen- thawed blastocysts in frozen-thawed embryo transfer cycles,explore the developmental potential of blastocysts during different developmental stages,provide a basis for further improving frozen-thawed embryo transfer program. Methods The clinical data of fresh blastocysts and frozen-thawed blastocysts in frozen-thawed embryo transfer cycles after in vitro fertilization / intracytoplasmic sperm injection（ IVF / ICSI） because of tubal factors or male factors was analyzed retrospectively. The cases were divided into D5 fresh blastocyst group,D6 fresh blastocyst group,D5 frozen- thawed blastocyst group and D6 frozen-thawed blastocyst group according to blastocyst formation and development time. Endometrium was prepared during natural cycles or estrogen replacement cycles,when endometrial thickness was more than 8 mm,progesterone transformation（ D0）was carried out,blastocyst culture of frozen-thawed embryos was started on the third day of endometrial transformation,D5 blastocysts and D6 blastocysts were obtained on the fifth day and the sixth day,respectively,frozen-thawed embryo transfer was performed on the fifth day of endometrial transformation after two hours,the clinical outcomes were compared between different groups. Results The implantation rate in D5 fresh blastocyst group was 48. 57%,which was statistically significantly higher than that in D6 fresh blastocyst group（ 26. 67%）（ P〈0. 05）. The clinical pregnancy rate in D5 fresh blastocyst group was 68. 52%,which was higher than that in D6 fresh blastocyst group（ 46. 67%）,but there was no statistically significant difference（ P〉0. 05）. The clinical pregnancy rate and implantation rate in D5 frozenthawed blastocyst group were 73. 72% and 55. 47%,respectively,which were statistically significantly higher than those in D6 frozen-thawed blastocyst group（ 47. 89% and 32. 39%,respectively）（ P〈 0. 01）. There was no statistically significant difference in clinical pregnancy rate,implantation rate,abortion rate and live birth rate between D5 / D6 fresh blastocyst groups and D5 / D6 frozen-thawed blastocyst groups（ P〉0. 05）. Conclusion Compared with D6 blastocyst transfer,D5 blastocyst transfer can improve implantation rate and achieve better clinical pregnancy outcomes,the surplus embryos can be cultured to blastocyst and cryopreservation after fresh embryo transfer cycle,the patients failing in embryo transfer repeatedly can receive frozen-thawed embryo transfer after blastocyst culture,which improve the utilization rate of embryos and clinical pregnancy outcomes.
出处
《中国妇幼保健》
CAS
2017年第4期804-807,共4页
Maternal and Child Health Care of China
关键词
冻融胚胎
玻璃化冷冻
囊胚移植
临床结局
Frozen-thawed embryo
Vitrification
Blastocyst transfer
Clinical outcome
