囊胚质量对冻融周期单囊胚移植策略选择的影响  

Effect of blastocyst quality on the strategy of single blastocyst transfer in frozen-thawed cycles

作　　者：汪彩珠[1] 冯贵雪[1] 张波[1] 周红[1] 舒金辉[1] 甘贤优[1] 林若芸[1] 陈焕华[1] 

机构地区：[1]广西壮族自治区妇幼保健院生殖中心,南宁530003

出　　处：《中华妇产科杂志》2016年第2期109-113,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：广西自然科学基金（2013GXNSFAA019258）;广西医疗卫生重点科研课题（重2011063、重2011065）;卫生公益性行业科研专项（201402004）;广西壮族自治区卫生和计划生育委员会课题（Z2012210）

摘　　要：目的探讨囊胚质量对冻融周期中单囊胚移植策略选择的影响。方法回顾性分析2008年1月-2013年12月在广西壮族自治区妇幼保健院生殖中心施行冻融周期单囊胚移植患者的临床资料，依据囊胚质量将单囊胚移植的患者分为4组，分别为AA组（765个周期）、AB／BA组（645个周期）、BB组（1005个周期）、BC／CB组（262个周期），比较各组的临床结局，并在此基础上，进一步探讨临床结局不理想的BC／CB组改行双囊胚移植的临床结局。结果冻融单囊胚移植周期中，AA、AB／BA、BB和BC／CB组患者的临床妊娠率为61．4％（470／765）、51．2％（330／645）、40．5％（407／1005）、22．9％（60／262），活胎分娩率为52．2％（399，765）、41．2％（266／645）、30．4％（306／1005）、13．7％（36／262），而流产率分别为13．6％（64／470）、16．7％（55，330）、21．4％（87／407）、35．0％（21／60）；随着囊胚质量的下降，临床妊娠率、活胎分娩率也显著下降（P〈0．01），流产率则显著上升（P〈0．01）。当移植1个评级≥BB级囊胚时，获得了可接受的临床妊娠率（均〉40％）和活胎分娩率（均〉30％），而移植1个BC／CB级囊胚时的临床妊娠率和活胎分娩率仅为22．9％和13．7％，显著低于评级≥BB级囊胚的各组，分别比较，差异均有统计学意义（P〈0．01）。进一步比较单个与2个BC／CB级囊胚移植的临床结局，后者的临床妊娠率[分别为38．5％（67／174）、22．9％，P〈0．01]、活胎分娩率[分别为30．5％（53，174）、13．7％，P〈0．01]明显升高，流产率则由35．0％下降至17．9％（12／67），两者比较，差异有统计学意义（P〈0．05）；后者的临床结局与移植单个BB级囊胚者（BB组）相似（P〉0．05），但多胎率增加达23．9％（16／67）。结论在冻融单囊胚移植周期中，随着囊胚质量的下降，其Objective To investigate the effect of blastocyst quality on the strategy of single blastocyst transfer in frozen-thawed cycles. Methods A retrospective analysis was performed in Reproductive Medicine Center, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region on clinical data of single frozen-thawed blastocyst transfer cycles from January 2008 to December 2013. All cycles were divided into four groups （AA, AB/BA, BB, BC/CB） according to the blastocyst score, then the clinical outcomes were compared between groups. And on this basis, the clinical outcomes were further explored when the group of outcomes with single blastocyst transfer wasn＇t ideal, which would diverted to transfer two blastocyst. Results In single frozen blastocyst transfer cycles, the clinical pregnancy rate of each group with the blastocyst scored AA, AB/BA, BB, BC/CB were 61.4% （470/765）, 51.2% （330/645）,40.5%（407/1 005）, 22.9%（60/262）, live births rate in each group were 52.2%（399/765）, 41.2% （266/645）, 30.4%（306/1 005）, 13.7%（36/262）, and the abortion rate were 13.6%（64/470）, 16.7%（55/330）, 21.4%（87/ 407）, 35.0%（21/60）, separately. This showed that the clinical pregnancy rate and live births rate decreased significantly with the decline of blastocyst quality （P〈0.01）, but the abortion rate showed significant upward trend （P〈0.O1）. When single blastocyst scored ≥BB grade transferred, an acceptable clinical pregnancy rate （〉40%） and live births rate （〉30%） could be obtained, however, the clinical pregnancy rate of 22.9% and live births rate of 13.7% could only be acquired when blastocyst scored BC/CB only transferred one embryo, which significant lower than those of each group scored ≥BB grade （P〈0.01）. So, after that, the blastocyst scored BC/CB were further divided into two groups （single blastocyst transferred versus two blastocyst transferred） to investigate, then the result showed that the clinical pregnancy rate [22.9% versus 38

关 键 词：胚胎移植 低温保存 胚胎植入 妊娠率 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]