摘要
目的探讨冻融周期单囊胚移植中影响临床结局的相关因素。方法回顾性分析本中心2016年1月至2020年10月期间行冻融周期单囊胚移植患者的979个周期的资料,根据单囊胚冷冻前的发育天数、囊胚的内细胞团(ICM)评分、滋养层细胞(TE)评分以及解冻后体外培养时间分成不同亚组,比较不同亚组间的一般资料及临床结局,采用Logistic多因素回归分析筛选影响因素,通过分类决策树建立最优多变量决定移植单囊胚顺序,选择最佳单囊胚移植策略。结果(1)单因素分析结果显示:发育天数D5囊胚组临床妊娠率显著高于D6囊胚组(64.4%vs.36.4%,P<0.05);随着3组ICM评分降低,妊娠率下降(81.5%vs.62.0%vs.33.1%),且差异有统计学意义(P<0.05);随着3组的TE级别降低,妊娠率也下降(72.4%vs.53.6%vs.32.7%),差异有统计学意义(P<0.05);D5和D6囊胚解冻后培养2~4 h移植组的妊娠率均显著高于解冻后培养16~20 h移植组(P<0.05)。(2)Logistic多因素分析结果显示,女方年龄(OR=0.964)、ICM评分(OR=0.423)、TE评分(OR=0.541)、体外发育时间(OR=0.351)与妊娠结局呈显著负相关(P<0.05),解冻后培养时间与妊娠结局呈显著正相关(OR=1.733)。(3)分类决策树模型显示,决策树包含2层,共4个节点,第一层为ICM级别(χ^(2)=49.438,P=0.000),第二层为解冻后体外培养时间(χ^(2)=6.502,P=0.011),交叉验证正确百分比为35.8%。结论在冻融周期单囊胚移植中,ICM评分低和解冻后培养16~20 h后移植是临床妊娠率低的危险因素。在选择单囊胚移植时,应根据ICM级别优先选择ICM评分为B级以上的D5囊胚,再根据TE级别选择TE评分为B级以上的囊胚,解冻后培养时间不宜过长。
Objective:To explore the related factors affecting clinical outcome in single frozen-thawed blastocyst transfer cycles.Methods:The data of 979 cycles of the patients who were transferred single frozen-thawed blastocyst in the Department of Reproductive Medicine from January 2016 to October 2020 were analyzed retrospectively.According to the blastocyst development days before freezing,the scores of inner cell mass(ICM)&trophoblast cell(TE),and in vitro culture time after thawed,the cycles were divided into different subgroups.The general data and clinical outcome were compared among the subgroups.Logistic regression analysis was performed to screen the influencing factors.The optimal multivariate selection procedure for single blastocyst transfer was established through classification decision tree for choosing the best single blastocyst transfer strategy.Results:(1)Single factor analysis showed that the clinical pregnancy rate of Day 5 blastocyst group was significantly higher than that of Day 6 blastocyst group(64.4%vs.36.4%,P<0.05).The clinical pregnancy rate was significantly decreased with the score of ICM decreased(81.5%vs.62.0%vs.33.1%,P<0.05).The clinical pregnancy rate was also significantly decreased with the scores of the TE decreased(72.4%vs.53.6%vs.32.7%)(P<0.05).The clinical pregnancy rate of Day 5 and Day 6 blastocysts cultured for 2-4 hours after thawed was significantly higher than that cultured for 16-20 hours after thawed.(2)Multifactor analysis showed that the female age(OR=0.964),the ICM score(OR=0.423),TE score(OR=0.541)and the development speed of blastocysts(OR=0.351)were negatively related to the clinical pregnancy rate,while culture for 2-4 hours after thawed was positively correlated with the clinical pregnancy rate(OR=1.733).(3)The classification decision tree model showed that the decision tree consists of three layers and four nodes.The first layer was the ICM score(χ^(2)=49.438,P=0.000),and the second layer was the in vitro culture time after thawed(χ^(2)=6.502,P=0.011).The correct percentage of cross-validation was 35.8%.Conclusions:In the single frozen-thawed blastocyst transfer cycles,low ICM score and culture for 16-20 hours after thawed were the risk factors for low clinical pregnancy rate.When selecting single blastocyst transfer,the Day 5 blastocysts with ICM above grade B were selected preferentially according to the grade of ICM,and then the blastocysts with TE grade above grade B were selected according to the TE grade.The culture time after thawed should not be too long.
作者
李昕妍
柴三明
李甫云
王琰
王志强
张霖
晏博
杨金伟
倪亚莉
LI Xin-yan;CHAI San-ming;LI Fu-yun;WANG Yan;WANG Zhi-qiang;ZHANG Lin;YAN Bo;YANG Jin-wei;NI Ya-li(Reproductive Medicine Center of Gansu Provincial Maternity and Child-care Hospital,Lanzhou 730050)
出处
《生殖医学杂志》
CAS
2021年第11期1438-1444,共7页
Journal of Reproductive Medicine
基金
甘肃省自然科学基金(20JR5RA138)
甘肃省卫生行业计划(GSWSKY2018-16)
甘肃省科技计划资助(18YF1WA045)。
关键词
单囊胚移植
冻融周期
形态学评分
体外培养时间
临床妊娠率
Single blastocyst transfer
Frozen-thawed cycle
Morphological score
In vitro culture time
Clinical pregnancy rate
