影响冻融胚胎发育潜能及妊娠结局因素的探讨  

Factors Affecting Embryonic Development Potential and Pregnancy Outcomes

作　　者：王宁怡[1] 孙晓溪[1] 陆朱娣[1] 曹英[1] 曹翔[1] 刘素英[1] 

机构地区：[1]上海集爱遗传与不育诊疗中心,上海200011

出　　处：《生殖与避孕》2012年第8期533-539,517,共8页Reproduction and Contraception

摘　　要：目的:探讨胚胎冷冻复苏后,卵裂球存活状态对胚胎发育的影响以及体外授精(IVF)和卵胞质内单精子注射(ICSI)2种授精方式对冷冻胚胎复苏后体外发育能力和妊娠结局的影响。方法:回顾性分析142例患者,150个复苏周期,共769个冷冻胚胎复苏后培养至囊胚期进行移植的结果。结果:共复苏胚胎769个,存活胚胎702个,复苏率91.3%。220个胚胎(31%)到达囊胚阶段。在卵裂球全部存活胚胎中,囊胚形成率35%,部分存活胚胎中囊胚形成率24%,两者有统计学差异(P<0.01)。在卵裂球全部存活胚胎中,来源于IVF的胚胎囊胚形成率为40%,来源于ICSI的为26%,两者有统计学差异(P<0.01);部分卵裂球存活胚胎中来源于IVF的胚胎囊胚形成率为26%,来源于ICSI的为19%,差异无统计学意义(P>0.05)。在全部220个囊胚中,IVF组的优质囊胚率为38.6%,ICSI组的优质囊胚率为21.0%,差异有统计学意义(P<0.05)。临床妊娠率IVF组和ICSI组分别为61.05%与61.11%;胚胎种植率分别为37.50%与36.67%,活产率分别为81.03%与78.79%,差异均无统计学意义(P>0.05)。结论:胚胎冷冻复苏后卵裂球的损伤削弱了囊胚形成能力,影响卵裂期胚胎进一步发育,这与ICSI和冷冻胚胎复苏后发育潜能的降低有关,但其对临床结果和妊娠结局的影响不大。Objective： To investigate the effects of blastomere loss and different insemination methods on the viability of frozen-thawed embryos and pregnancy outcomes. Methods： The embryo survial and blastcyst formation were studied retrospectively in 150 frozen-thawed transfer cycles of 142 infertil patients. Results： A total of 769 cryopreserved embryos were thawed, 702 embryos survived with at least 50% of their blastomeres intact following thawing. The survival rate after thawing was 91.29%. Two hundred and twenty embryos of these embryos reached blastocyst stage. The proportion of embryos developing to the blastocyst stage was 35% in fully intact thawed embryos. The proportion of embryos which formed blastocysts in vitro was 24% in partially intact thawed embryos, the difference was statistically significant （P〈0.01）. The blastocyst formation rates of IVF-derived and ICSI-derived embryos in fully intact thawed embryos were 40% and 26%, respectively, the difference was statistically significant （P〈0.01）. The blastocyst formation rates of IVF-derived and ICSI-derived embryos in partially intact thawed embryos were 26% and 19%, respectively, the difference was not significant （P〉0.05）. The percentages of good-quality blastocyst were 38.6% in IVF group and 21.0% in ICSI group, the difference was significant （P〈0.05）, the clinical pregnancy rates were 61.05% and 61.11%, respectively （P〉0.05）, the implantation rates were 37.50% and 36.67%, respectively （P〉0.05）, the live birth rates were 81.03% and 78.79%, respectively （P〉0.05）. Conclusion： Blastomere loss after frozen-thawing impairs capacity for blastocyst formation. ICSI is related to the reduced viability of frozen-thawed embryo, but it has no negative effect on implantation rate and clinical pregnancy rate.

关 键 词：卵裂球 囊胚 冷冻 IVF ICSI 

分 类 号：R714.8[医药卫生—妇产科学]