人工皱缩囊胚腔对囊胚玻璃化冷冻后妊娠结局的影响  

Effects of artificial shrinkage of blastocoeles before vitrification on pregnancy outcome

作　　者：冯贵雪[1] 张波[1] 舒金辉[1] 周红[1] 周莉[1] 甘贤优[1] 刘茵[1] 

机构地区：[1]广西壮族自治区妇幼保健院生殖医学中心,南宁530003

出　　处：《中华妇产科杂志》2010年第11期838-842,共5页Chinese Journal of Obstetrics and Gynecology

摘　　要：目的 探讨人工皱缩囊胚腔对囊胚玻璃化冷冻的效果、妊娠结局及新生儿的影响.方法 2006年1月至2009年12月,选择在广西壮族自治区妇幼保健院生殖医学中心接受体外受精-胚胎移植（IVF-ET）或卵母细胞胞质内单精子注射（ICSI）治疗的患者,新鲜胚胎移植妊娠失败后要求行冻融囊胚移植的342个周期,其中,314个周期的囊胚在玻璃化冷冻前,用显微注射针刺入囊胚腔内抽出囊胚液使之皱缩,然后以玻璃微细管为载体行玻璃化冷冻（皱缩组）,28个周期未行囊胚腔人工皱缩（未皱缩组）.比较两组经冷冻、复苏及移植后的胚胎存活率、种植率、临床妊娠率和取消移植率等.在已妊娠者中,比较两组的流产率、活胎分娩率、分娩孕周、新生儿出生缺陷发生率、新生儿平均出生体质量等,并与同期新鲜移植周期（新鲜周期组,520个周期）进行比较.结果 皱缩组胚胎存活率、种植率及临床妊娠率分别为95.3%（403/423）、38.0%（153/403）、44.6%（140/314）,未皱缩组分别为64.3%（27/42）、7.4%（2/27）、7.1%（2/28）,分别比较,差异均有统计学意义（P＜0.05）;皱缩组取消移植率为0,未皱缩组为25.0%（7/28）,两组比较,差异也有统计学意义（P＜0.05）.皱缩组的流产率[18.2%（10/55）]、活胎分娩率[80.0%（44/55）]、分娩孕周[（38.2±1.3）周]、新生儿出生缺陷发生率[2.1%（1/47）]、新生儿平均出生体质量[（2989±640）g]与新鲜周期组[17.5%（91/520）、74.0%（385/520）、（37.9±2.3）周、1.7%（8/479）、（2856±640）g]比较,差异均无统计学意义（P＞0.05）.结论 人工皱缩囊胚腔能明显提高囊胚玻璃化冷冻效果,并且新生儿先天异常发生率无明显升高.Objective To investigate the effects on pregnancy outcome and neonate by artificial shrinkage by microsucting the fluid of expanded blastocysts before vitrification using glass micropipette （GMP）.Methods From Jan.2006 to Dec.2009, 342 vitrified-thawed blastocyst cycles from patients that performed in vitro fertilization-embryo transfer （IVF-ET） or intracyteplasmic sperm injection （ ICSI ） were enrolled in this study in Reproductive Medicine center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region.Three hundred and fourteen cycles of expanded blastocysts were artificially shranked by microsucting blastocoelic fluid with a micro-needle before vitrification as artificial shrinkage group, in the mean time, 28 cycles without artificial shrinkage were chosed as control group.The survival rate, implantation rate, clinical pregnancy rate and transfer canceled rate were compared between artificial shrinkage group and control group.Among pregnant women, the miscarriage rate, live birth rate, congenital birth defect rate, neonatal weight and gestational age were compared with those of fresh embryo transfers in 520 cycles.Results The blastocyst survival rate, implantation rate and clinical pregnancy rate were 95.3%（403/423）, 38.0% （ 153/403）, 44.6% （140/314） in artificial shrinkage group and 64.3 % （27/42）,7.4% （2/27）, 7.1% （2/28） in control group, respectively, which reached statistical difference （P〈0.05）.The transfer canceled rate was 0 in artificial shrinkage group and 25.0% （7/28） in control group, which also reached statistical difference （ P 〈 0.05 ）.Among pregnant patients, the miscarriage rate of 18.2% （10/55）, live birth rate of 80.0% （44/55）, gestational age of （38.2 ± 1.3） weeks, congenital birth defect rate of 2.1% （1/47）, birth weight of newborns of （2989 ±640） gram in artificial shrinkage group were not significantly different with 17.5% （91/520）, 74.0% （385/520）, （37.9 ±2.3） weeks,1.7% （8/479） and

关 键 词：胚胎移植 囊胚 冷冻 妊娠结局 婴儿 新生 

分 类 号：R686[医药卫生—骨科学]