冷冻囊胚复苏移植对卵巢储备功能下降患者的应用价值  

The application of frozen-thawed blastocyst transfer in patients with diminished ovarian reserve

作　　者：明琪 随刘才 李美玲[1] 孙琴 许娟娟 姚兵[1] 梁元姣[1] MING Qi,SUI Liu-cai,LI Mei-ling,SUN Qin,XU Juan-juan,YAO Bing,LIANG Yuan-jiao(Center of Reproductive Medicine,Jinling Hospital,Southern Medical University/Nanjing General Hospital of Nanjing Military Region,PLA,Nanjing 210002,Jiangsu,Chin)

机构地区：[1]南方医科大学金陵医院(南京军区南京总医院)生殖医学中心,南京医学硕士研究生210002

出　　处：《医学研究生学报》2018年第5期494-499,共6页Journal of Medical Postgraduates

基　　金：南京军区优生优育专项重点课题(15ZD036)

摘　　要：目的多数胚胎实验室在实施胚胎培养中观察胚胎发育后5~6 d。文中探讨冷冻周期中D6+D7囊胚复苏移植在卵巢储备功能下降患者中应用价值。方法回顾性分析2015年1月1日至2017年12月31日期间因卵巢储备功能下降(DOR)在南京总医院生殖医学中心行体外受精-胚胎移植患者285例。所有研究对象通过自然周期、微刺激及黄体期促排卵获得冷冻胚胎后行冻融胚胎复苏移植,共计442个周期,按移植胚胎生命期不同分为卵裂球组和囊胚组,比较2组患者的一般资料及妊娠结局。再将移植囊胚组按胚龄分为D5囊胚和D6+D7囊胚2组,比较各自不同的妊娠结局。结果移植卵裂球组周期数291、囊胚组周期数151,2组胚胎种植率(22.46%vs 44.62%)、临床妊娠率(33.33%vs 50.33%)、继续妊娠率(21.65%vs37.75%)及流产率(35.05%vs 25.00%),差别均有统计学意义(P<0.05)。冷冻囊胚移植周期中,D5囊胚移植周期数69,D6+D7囊胚移植周期数76,2组的胚胎种植率(39.74%vs 50%)、临床妊娠率(44.93%vs 55.26%)、继续妊娠率(34.78%vs39.47%)和流产率(22.58%vs 28.57%),差异无统计学意义(P>0.05)。结论卵巢储备功能下降患者的冻融胚胎复苏移植周期中,移植囊胚能明显改善患者妊娠结局。DOR患者在形成胚胎数目有限时可考虑移植D6或D7优质囊胚,也可获得一定的临床妊娠率。Objective The embryonic development is usually observed for 5-6 days during the process of embryo culture in most embryonic laboratories. The article aimed to explore the application of D6＋D7 frozen-thawed blastocyst transfer in patients with diminished ovarian reserve（ DOR）. Methods Retrospective analysis was conducted on 285 patients with DOR who were treated with invitro fertilization and embryo transfer（ IVF-ET） in our center from2015 to 2017. Frozen embryos were harvested from the natural cycle,mini-stimulation protocol,ovulation induction during the luteal phase,followed by frozen-thawed embryo transfer with a total of 442 cycles.The frozen embryos were divided into cleavage embryo group and blastocyst group according to different life stages,and comparison was made in general data and pregnancy outcome between the two groups.The blastocyst transfer group was subdivided into Day5 group and Day6＋Day7 group followed by the comparison of different pregnancy outcome between the two groups. Results Patients with DOR were treated with frozen-thawed blastocyst transfer with 291 cycles in cleavage embryo group and 151 cycles in blastocyst group. The implantation rate,clinical pregnancy rate,and ongoing pregnancy rate of blastocyst group were significantly higher than those of cleavage embryo group（ 44.62% vs 22.46%,50.33% vs 33.33%,37.75% vs21.65%,P〈0.05） and the abortion rate of blastocyst group was significantly lower than that of cleavage embryo group（ 35.05% vs25%,P〈0.05）. As to the frozen blastocyst transplantation cycle,the number of D5 blastocysts was 69,and D6＋D7 blastocyst was 76.The embryo planting rate,clinical pregnancy rate,continued pregnancy rate and abortion rate of D6＋D7 group were higher than those of D5 group（ 39.74% vs 50%,44.93% vs 55.26%,34.78% vs 39.47%,22.58% vs 28.57%）,but the difference was of no statistical significance（ P〈0.05）. Conclusion In patients with DOR,the transplanted blastocyst can significantly improve the pregnancy outcome,increase the cl

关 键 词：卵巢储备功能下降 冻融胚胎复苏移植 临床妊娠率 胚胎种植率 流产率 

分 类 号：R711.75[医药卫生—妇产科学]