囊胚解冻过夜培养后移植对妊娠结局的影响  

Impact of Pregnancy Outcomes for Overnight Cultured Thawed-Frozen Blastocyst transfer

作　　者：岳超敏[1] 方丛[1] 宫晓[2] 李俐琳[1] 李婷婷[1] 梁晓燕[1] 

机构地区：[1]中山大学附属第六医院生殖中心,广东广州510610 [2]中山大学公共卫生学院医学统计与流行病学系,广东广州510080

出　　处：《中山大学学报（医学科学版）》2013年第3期415-421,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：国家自然科学基金(81070495)

摘　　要：【目的】比较行囊胚移植的复苏周期中,解冻后经2～3 h培养或过夜培养后移植对妊娠结局的影响。【方法】回顾性分析本中心2010年9月至2012年10月进行复苏周期囊胚移植的523个周期资料,按照解冻后至移植前时间不同分为2组:解冻2～3 h后当天移植(0TET,n=247)、提前1 d解冻过夜培养后移植(1TET,n=276),对其妊娠结局进行比较。【结果】1TET组与0TET组相比移植了较少的胚胎个数(1.6 vs.1.8,P<0.001),获得较高的妊娠率(57.6%vs.56.3%)、种植率(46.3%vs.44.1%)和较低的流产率(9.4%vs.12.2%)、多胎率(28.3%vs.36.7%)。但除移植胚胎个数外,其他各妊娠结局指标的差异无统计学意义。人工周期(HRT)作内膜准备获得较高的妊娠率(62.8%vs.53.0%,P=0.027)。单囊胚移植周期分析发现,第5天发育为囊胚的胚胎比第6天的囊胚具有较高的种植率(57.6%vs.36.1%,P=0.004)。【结论】提前1 d解冻囊胚过夜培养后再移植不会影响主要妊娠结局。影响妊娠率的因素有内膜准备方法和发育为囊胚的天数。降低多胎率可考虑D5单囊胚移植。[Objective] To compare the impact of pregnancy outcomes when frozen blastocyst was transferred 2 to 3 hours after being thawed or 16 to 20 hours after being cultured overnight.[Methods] Retrospectively analyze the 523 cycles of thawed blastocyst transfer from September 2010 to October 2012.All the cycles are divided into two groups based different culture time before transfer：those blastocysts transferred 2 to 3 hours after being thawed are labeled as OTET group（n =247） and those cultured overnight before being transferred the next day are included in 1TET group （n =276）.The pregnancy outcomes are compared between the two groups.[Results] Compared with 0TET group,1TET group with less embryo transferred （1.6 vs.1.8,P 〈 0.001） has higher clinical pregnancy rate （57.6% vs.56.3%）,implantation rate （46.3% vs.44.1%） and lower miscarriage rate （9.4% vs.12.2%） as well as lower multiple-pregnancy rate （28.3% vs.36.7%）.However,all differences between the two groups have not yet reached the statistical significance except number of blastocyst transferred.Hormone replaced treatment as endometrium preparation method for blastocyst transfer has higher clinical pregnancy rate （62.8% vs.53.0%,P =0.027）.Blastocysts frozen at the fifth day after fertilization have higher implantation potential than those frozen at the sixth day （implantation rate 57.6% vs.36.1%,P =0.004） based analysis of cycle data of single blastocyst transfer.[Conclusion] Overnight culture of thawed blastocyst before transfer does not affect the main pregnancy outcomes.The factors related with pregnancy outcomes are endometrium preparation methods and blastocyst developmental stages.To decrease the multiple-pregnancy rate,single embryo transfer of D5 should be encouraged.

关 键 词：胚胎玻璃化冷冻 囊胚移植 复苏胚胎移植 自然周期 人工周期 

分 类 号：R711.6[医药卫生—妇产科学]