胚龄对于CC级别单囊胚冻融移植周期妊娠结局的影响  

Effect of embryonic age on the pregnancy outcomes of blastocysts graded as CC in single frozen-thawed blastocyst transfer cycles

作　　者：赵明 黄亚 杜通[2] 林嘉盈 祁秀娟 徐利 陆文怡 匡延平[2] ZHAO Ming;HUANG Ya;DU Tong;LIN Jia-ying;QI Xiu-juan;XU Li;LU Wen-yi;KUANG Yan-ping(Department of Assisted Reproduction,Shanghai TOWAKO Hospital,Shanghai 200131,China;Department of Assisted Reproduction,Shanghai Ninth People's Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China)

机构地区：[1]上海永远幸妇科医院生殖医学中心,上海200131 [2]上海交通大学医学院附属第九人民医院辅助生殖科,上海200011

出　　处：《上海交通大学学报（医学版）》2021年第4期502-508,共7页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海交通大学医学院附属第九人民医院基础研究助推计划(JYZZ117)。

摘　　要：目的·探讨单囊胚冻融移植周期中胚龄对CC级别囊胚妊娠结局的影响。方法·纳入2017年4月—2019年12月于上海永远幸妇科医院进行单个冻融囊胚移植的565例患者,分为高质量囊胚组(AA、AB、BA级,n=189)、中质量囊胚组(BB、AC、CA级,n=114)、低质量囊胚组(CB、BC级,n=140)和CC级别囊胚组(n=122)。其中,CC级别囊胚组按照胚龄进一步分为D5亚组(n=26)、D6亚组(n=81)和D7亚组(n=15)。对4个不同级别囊胚组及3个CC级别囊胚胚龄亚组的周期特征及妊娠结局进行比较。结果·高质量囊胚组、中质量囊胚组、低质量囊胚组、CC级别囊胚组的临床妊娠率(58.7%vs 54.4%vs 47.1%vs 25.4%,P=0.000)和活产率(46.2%vs 43.2%vs 36.2%vs 17.6%,P=0.000)依次降低。多元回归分析显示,胚胎质量与临床妊娠率显著相关。与高质量囊胚相比,CC胚胎的临床妊娠率较低(a OR=0.81,95%CI 0.71~0.93,P=0.003)。CC级别囊胚胚龄亚组分析显示,D5、D6和D7亚组的临床妊娠率(42.3%vs 23.5%vs 6.7%,P=0.040)和活产率(31.6%vs 15.6%vs 0,P=0.133)依次降低。多元回归分析显示,胚龄对CC级别囊胚移植临床妊娠率有显著影响。相较于D5的CC级别胚胎,D7的CC级别胚胎的临床妊娠率更低(a OR=0.69,95%CI 0.49~0.96,P=0.032)。结论·D5的CC级别囊胚具有很好的妊娠结局,临床价值高。D6的CC级别囊胚虽然妊娠率较低,但仍具有一定的临床价值,而D7的CC级别囊胚临床价值较小。Objective·To assess the effect of embryonic age on the pregnancy outcomes of blastocyst graded as CC in single frozen-thawed blastocyst transfer cycles.Methods·A total of 565 patients undergoing single frozen-thawed blastocyst transfer at Shanghai TOWAKO Hospital from April 2017 to December 2019 were included in this study,and they were divided into high-quality blastocyst group(grade AA,AB,and BA;n=189),medium-quality blastocyst group(grade BB,AC,and CA;n=114),low-quality blastocyst group(grade CB and BC;n=140)and CC grade blastocyst group(n=122).And the CC grade blastocysts were further divided into CC grade blastocysts of Day 5(D5 subgroup,n=26),Day 6(D6 subgroup,n=81)and Day 7(D7 subgroup,n=15)according to the embryonic age.Thereafter,the cycle characteristics and pregnancy outcomes of the four groups and the three embryonic age subgroups of CC grade blastocysts were compared.Results·The clinical pregnancy rate(58.7%vs 54.4%vs 47.1%vs 25.4%,P=0.000)and live birth rate(46.2%vs 43.2%vs 36.2%vs 17.6%,P=0.000)of the high-quality,medium-quality,low-quality,and CC grade blastocyst groups decreased sequentially.Multivariate analysis showed that embryo quality was significantly correlated with clinical pregnancy rate.Compared with high-quality blastocyst group,CC grade blastocyst group had a lower clinical pregnancy rate(a OR=0.81,95%CI 0.71-0.93,P=0.003).The analysis of CC grade blastocyst embryonic age subgroups showed that the clinical pregnancy rate(42.3%vs 23.5%vs 6.7%,P=0.040)and live birth rate(31.6%vs 15.6%vs 0,P=0.133)of the D5,D6 and D7 subgroups also decreased sequentially.Multivariate analysis showed that the embryonic age had a significant impact on the clinical pregnancy rate of CC grade blastocyst transfer.Compared with the D5 subgroup,the D7 subgroup had a lower clinical pregnancy rate(a OR=0.69,95%CI 0.49-0.96,P=0.032).Conclusion·D5 CC grade blastocysts predict good pregnancy outcome.Although the clinical pregnancy rate of D6 CC grade blastocysts is low,they are still useable.However,D7 CC grade

关 键 词：囊胚质量 CC级别囊胚 临床妊娠率 单囊胚冻融移植 

分 类 号：R711.6[医药卫生—妇产科学]