D5囊胚解冻后培养时间对妊娠结局的影响  

Effects of culture time of Day 5 blastocysts after thawed on pregnancy outcome

作　　者：刘军霞[1] 熊顺[1] 韩伟[1] 武丽红[1] 黄国宁[1] LIU Jun-xia;XIONG Shun;HAN Wei;WU Li-hong;HUANG Guo-ning(Chongqing Key Laboratory of Human Embryo Engineering,Chongqing Reproductive Medicine Center,Chongqing Health Center for Women&Children,Chongqing 400013)

机构地区：[1]重庆市妇幼保健院生殖医学中心,人类胚胎工程重庆市重点实验室,重庆400013

出　　处：《生殖医学杂志》2020年第12期1545-1550,共6页Journal of Reproductive Medicine

基　　金：中华医学会临床医学科研专项基金项目(17020440713);重庆市科卫联合医学科研项目(2019MSXMO67)。

摘　　要：目的探讨D5玻璃化冷冻的囊胚解冻后体外培养时间对妊娠结局的影响,优化囊胚冻融周期移植策略。方法回顾性分析我院2018年7月至2019年12月期间1571例年龄小于38岁患者的D5冻融优质囊胚移植周期的资料。根据解冻后培养时间分为A组(培养2~4 h)和B组(过夜培养16~20 h);各组根据移植囊胚数目再进一步细分为两个亚组,即移植2枚囊胚的A2组(n=459)和B2组(n=658),以及移植1枚囊胚的A1组(n=218)和B1组(n=236)。比较不同组间的种植率、临床妊娠率、流产率和继续妊娠率等。结果双囊胚移植:A2组种植率、临床妊娠率和继续妊娠率均显著高于B2组(分别为62.96%vs.49.47%;81.26%vs.70.82%;74.94%vs.61.25%)(P<0.05),且A2组流产率显著降低(6.17%vs.10.94%,P<0.05)。单囊胚移植,A1组种植率、临床妊娠率和继续妊娠率均显著高于B1组(分别为71.10%vs.60.17%;71.10%vs.60.17%;65.14%vs.50.85%)(P<0.05)。Logistic回归分析表明:囊胚解冻后是否过夜培养与临床妊娠率[OR=0.581,95%CI(0.459,0.734)]及流产率[OR=1.894,95%CI(1.179,3.041)]显著相关(P<0.05),过夜培养与临床妊娠率呈负相关,与流产率呈正相关。结论与过夜培养比较,D5囊胚解冻后培养2~4 h移植可以显著提高临床妊娠率、种植率和继续妊娠率并降低流产率,是优化的冻融囊胚周期移植策略。Objective:To explore the effect of in vitro culture time of vitrified Day 5 blastocysts after thawed on pregnancy outcome,and optimize blastocyst frozen-thawed cycle transfer strategy.Methods:The data of the Day 5 frozen-thawed high-quality blastocyst transfer cycle of 1571 patients younger than 38 years old in our hospital from July 2018 to December 2019 were retrospectively analyzed.The cycles were divided into group A(2-4 hours)and group B(16-20 hours)according to culture time after thawed.According to the number of blastocysts transferred,the cycles were further divided into two subgroups:the double blastocysts were transferred:group A2(n=459)and group B2(n=658);the single blastocyst were transferred:group A1(n=218)and B1 group(n=236).The implantation rate,clinical pregnancy rate,miscarriage rate and continued ongoing pregnancy rate were compared among the different groups.Results:Double blastocyst transfer:the implantation rate,clinical pregnancy rate and continued pregnancy rate in group A2 were significantly higher than those in group B2(62.96%vs.49.47%;81.26%vs.70.82%;74.94%vs.61.25%)(P<0.05),and the abortion rate in group A2 was significantly reduced(6.17%vs.10.94%,P<0.05).Single blastocyst transfer:the implantation rate,clinical pregnancy rate and ongoing pregnancy rate of group A1 were significantly higher than those of group B1(71.10%vs.60.17%;71.10%vs.60.17%;65.14%vs.50.85%,respectively)(P<0.05).Logistic regression analysis showed that whether the blastocyst was cultured overnight after thawed was significantly correlated to the clinical pregnancy rate[OR=0.581,95%CI(0.459,0.731),P<0.05]and miscarriage rate[OR=1.894,95%CI(1.179,3.041),P<0.05].Overnight culture was negatively correlated with the clinical pregnancy rate and positively correlated with the miscarriage rate.Conclusions:Compared with overnight culture,transplantation of Day 5 blastocysts cultured for 2-4 hours after thawed can significantly improve the clinical pregnancy rate,implantation rate and ongoing pregnancy rate,and reduce miscarri

关 键 词：囊胚移植 冻融囊胚 体外培养时间 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]