胚胎玻璃化冷冻后储存时间对复苏周期胚胎移植临床结局的影响  

Effect of storage time after vitrification of embryos on clinical outcome of frozen-thawed cycle

作　　者：韩乐 蔡令波 孟慧 李婷 刘嘉茵 HAN Le;CAI Ling-bo;MENG Hui;LI Ting;LIU Jia-yin(State Key Laboratory of Reproductive Medicine,the First Affiliated Hospital,Nanjing Medical University,Nanjing 210029)

机构地区：[1]生殖医学国家重点实验室,南京医科大学第一附属医院生殖医学中心,南京210029

出　　处：《生殖医学杂志》2020年第10期1261-1267,共7页Journal of Reproductive Medicine

基　　金：江苏省妇幼保健协会科研项目(FYX201917);国家重点研发计划(2016YFC1000703);卫生部行业科研专项课题(201402004);江苏省卫生厅科教强卫工程(YXZXB2016001)。

摘　　要：目的探讨玻璃化冷冻胚胎保存时长对复苏周期临床结局的影响。方法回顾性分析2014年1月至2017年12月我中心行玻璃化冷冻胚胎复苏移植的19574个周期,按胚胎冻存时间分为6组:1~6个月组(15443个周期),7~12个月组(2321个周期),13~24个月组(903个周期),25~36个月组(327个周期),37~48个月组(224个周期)和≥49个月组(356个周期)。对各组胚胎复苏后的胚胎复苏率、种植率、HCG阳性率、临床妊娠率、流产率、单卵双胎率、新生儿性别比等指标进行比较。结果(1)总体:解冻胚胎复苏率随着胚胎冻存时间的延长显著下降,1~6个月组最高为98.23%,≥49个月组最低为90.52%(P<0.01);HCG阳性率和临床妊娠率在1~6个月组最高(分别为66.80%和60.88%,P<0.01);单卵双胎、新生儿出生体重和出生性别比各组间均无显著差异(P>0.05);(2)囊胚亚组:解冻囊胚复苏率、单卵双胎率在各组间均无显著差异(P>0.05);1~6个月组种植率、HCG阳性率、临床妊娠率最高,分别为72.07%、77.83%和72.77%,而≥49个月组种植率、HCG阳性率、临床妊娠率最低,均为50%(P<0.01)。结论随着冷冻保存时间的延长,胚胎复苏率显著下降;短期保存(≤6个月)可以获得较高的临床妊娠率;尽管胚胎长期保存并不影响到其出生婴儿的健康状况,但如果条件允许,冷冻保存的胚胎应尽早复苏。Objective:To investigate the effects of embryo cryopreservation storage time on clinical outcomes of frozen-thawed cycles.Methods:The data of 19574 cycles of vitrified-thawed embryo transfer(FET)in our center from January 2014 to December 2017 were retrospectively analyzed.The cycles were divided into six groups according to embryo cryopreservation time:1-6 months(15443 cycles),7-12 months(2321 cycles),13-24 months(903 cycles),25-36 months(327 cycles),37-48 months(224 cycles),and≥49 months(356 cycles).The embryonic survival rate,implantation rate,HCG positive rate,clinical pregnancy rate,abortion rate,monozygotic twin rate,and neonatal sex ratio after frozen-thawed embryo transfer were compared among the groups.Results:(1)In the total FET cycles,the embryo survival rate was decreased significantly with the increase of cryopreservation time,and the highest rate was 98.23%in the 1-6 months group,and the lowest was 90.52%in the≥49 months group(P<0.01).The HCG positive rate(66.80%)and clinical pregnancy rate(60.88%)in the 1-6 months group were the highest(P<0.01).There were no significant differences in monozygotic twin rate,neonatal birth weight,and sex ratio of newborns among the groups(P>0.05).(2)In the frozen-thawed blastocyst transfer cycles,there was no significant difference in the blastocyst survival rate and the monozygotic twin rate among the groups(P>0.05).The implantation rate(72.07%),HCG positive rate(77.83%),and clinical pregnancy rate(72.77%)in the 1-6 month group were the highest,while the implantation rate,HCG positive rate and clinical pregnancy rate of≥49 months group were the lowest,all of them were 50%(P<0.01).Conclusions:With the prolongation of cryopreservation time,the embryonic survival rate was decreased significantly.Short-term cryopreservation(≤6 months)can obtain higher clinical pregnancy rate.Therefore,although long-term cryopreservation of the embryo has no effect on the health of the new baby,but cryopreserved embryos should be recovery as soon as possible if condition allows.

关 键 词：胚胎冷冻保存 玻璃化冷冻保存 保存时间 胚胎复苏 婴儿健康 

分 类 号：R711.6[医药卫生—妇产科学]