影响单囊胚冻融移植周期活产结局的相关因素分析  

Factors affecting live birth of single frozen-thawed blastocyst transfer cycle

作　　者：郭娜[1] 远孝琼 邓陶然 谈慧平 殷莉[1] 李豫峰[1] 靳镭[1] GUO Na;YUAN Xiao-qiong;DENG Tao-ran;TAN Hui-ping;YIN Li;LI Yu-feng;JIN Lei(Reproductive Medicine Center,Tongji Hospital,Tongji Medical College,Huazhong University of Science&Technology,Wuhan 430000)

机构地区：[1]华中科技大学同济医学院附属同济医院生殖中心,武汉430000

出　　处：《生殖医学杂志》2020年第6期716-721,共6页Journal of Reproductive Medicine

基　　金：国家重点研发计划项目(2018YFC1002103);国家自然科学基金(81771654,81701520)。

摘　　要：目的分析影响单囊胚冻融移植周期活产结局的相关因素,探讨单囊胚移植的可行性。方法回顾性分析2012年1月至2016年12月在本中心接受单囊胚冻融移植的共2593个周期的临床资料,根据妊娠结局分为活产组(1058个周期)和非活产组(1535个周期),同时进行年龄(<35岁、35~39岁、≥40岁)和囊胚质量/发育速度分层分析,研究影响单囊胚冻融移植活产结局的相关因素。结果(1)活产组移植年龄中位数显著小于非活产组(31岁vs.32岁),移植日内膜厚度(9.2 mm vs.9.0 mm)和优质囊胚率(72.5%vs.62.5%)则显著高于非活产组(P<0.05)。(2)不同女性年龄组内随着内细胞团和滋养层细胞评分等级降低活产率降低,差异有统计学意义(P<0.05),但并未发现不同囊胚腔扩张等级对活产率的影响(P>0.05);对于年龄<35岁和35~39岁患者,D5囊胚移植较D6/D7囊胚移植具有更高的活产率,差异有统计学意义(P<0.05)。(3)年龄<35岁的女性单囊胚移植活产率高于35岁以上具有相同囊胚评级的患者,并且年龄<35岁BB及以上评级的单囊胚移植可获得>45%的活产率。结论女方年龄、囊胚质量及囊胚发育速度对单囊胚冻融移植周期活产结局有显著影响。复苏周期中35岁以下女性移植单个优质囊胚的活产率可达45%以上,提示单囊胚移植可行。制定个体化胚胎选择策略是确保单胚胎移植成功率的关键。Objective:To investigate the related factors affecting the live-birth in frozen-thawed single blastocyst transfer cycles,and explore the feasibility of single blastocyst transfer.Methods:The data of 2593 single frozen-thawed blastocyst transfer cycles in our center from January 2012 to December 2016 were retrospectively analyzed.According to pregnancy outcomes,the cycles were divided into live birth group(1058 cycles)and non-live birth group(1535 cycles),and stratified analysis was performed according to the age and blastocyst quality/development speed.The relevant factors affecting the live birth outcome were assessed.Results:The female age of live birth group was significantly younger than that in the non-live birth group(31 years vs.32 years),but the endometrial thickness on transfer day(9.2 mm vs.9.0 mm)and the high-quality blastocyst rate(72.5%vs.62.5%)were significantly higher than those in the non-live birth group(P<0.05).In different female age groups,the live birth rate was significantly decreased along with the decrease of internal cell mass and trophoblast cell score(P<0.05),but did not find the effect of different blastocyst cavity expansion grades on live birth rate(P>0.05).The live birth rate of D5 blastocyst transfer was significantly higher than that of D6/D7 blastocyst transfer for patients aged<35 years and 35-39 years(P<0.05).The live birth rate of women aged<35 years was significantly higher than that of>35 years with same score of blastocyst.The patients aged<35 years and a blastocyst grading≥BB can obtain a live birth rate>45%.Conclusions:The female age,blastocyst quality,and blastocyst development speed can significantly affect the live birth rate of single frozen-thawed blastocyst transfers cycles.In the frozen-thawed cycle,the live birth rate of single high-quality blastocyst transplantation for women<35 years old can reach more than 45%,suggesting that single blastocyst transplantation is feasible.Developing an individualized embryo selection strategy is the key to ensure the success r

关 键 词：单囊胚移植 囊胚发育速度 囊胚评分 活产率 

分 类 号：R711.6[医药卫生—妇产科学]