囊胚形态学评分对单囊胚移植围产儿结局的影响  

Effect of blastocyst morphological score on perinatal outcome of single blastocyst transfer

作　　者：高亚谊 张琍钧 王兴玲[1] 刘慧[2] 王静静 田萌萌 Gao Yayi;Zhang Lijun;Wang Xingling(Infertility Center,the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第三附属医院生殖中心,郑州450052 [2]河南省人民医院,郑州450003 [3]焦作市妇幼保健院生殖中心,焦作454100

出　　处：《现代妇产科进展》2021年第10期769-775,共7页Progress in Obstetrics and Gynecology

摘　　要：目的:探讨囊胚形态学评分对单囊胚移植围产儿结局的影响,为临床单囊胚移植的安全性和有效性提供依据。方法:回顾分析郑州大学第三附属医院生殖中心2015年8月1日至2019年12月25日接受新鲜和冷冻单囊胚移植妇女的临床资料,采用多因素logistic回归分析探讨囊胚扩张程度、ICM分级和TE分级对围产儿结局的独立影响。结果:研究共纳入1627个新鲜周期和3052个冷冻周期,其中812个新鲜周期和1332个冷冻周期获得了单胎活产,单胎活产率分别是49.9%和43.6%。无论是在新鲜周期还是FET周期中,囊胚扩张分期、ICM分级和TE分级与LGA、SGA、FM、LBW以及PTB均无明显相关性。新鲜周期中,ICM分级为“B”的新生儿男性比例明显高于分级为“A”的囊胚[OR 95%CI为2.17(1.51~2.94),P<0.001];而TE分级为“B”、“C”的囊胚较“A”的囊胚新生儿男性比例均降低(P=0.001),OR(95%CI)分别是0.56(0.38~0.78)和0.35(0.22~0.55)。FET周期中,TE分级为“B”和“C”的囊胚较分级为“A”的囊胚新生儿男性比例显著降低(P=0.001),所对应的OR(95%CI)分别是0.78(0.54~1.10)和0.53(0.36~0.78)。结论:形态学评分较低的囊胚并不会增加不良围产儿结局的发生风险。TE分级较高的囊胚移植后更有可能获得男性新生儿。新鲜周期中ICM分级为“B”的囊胚较“A”子代男性的比例明显增加。Objective:To investigate the effect of blastocyst morphological score on the perinatal outcome of single blastocyst transfer,and to provide basis for the safety and effectiveness of clinical single blastocyst transfer.Methods:The clinical data of women who received fresh or frozen single blastocyst transfer in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from August 1st,2015 to December 25th,2019 were retrospectively analyzed.Multivariate logistic regression analysis was used to explore the independent effects of blastocyst expansion,ICM grade and TE grade on perinatal outcome.Results:A total of 1627 fresh cycles and 3052 FET cycles were included in the study,of which 812 fresh cycles and 1332 FET cycles obtained singleton live births,which were 49.9%and 43.6%,respectively.No significant correlation was found between blastocyst expansion stage,ICM grade,TE grade and neonatal LGA,SGA,FM,LBW and PTB in both fresh cycle and FET cycle.In the fresh cycle,the proportion of male newborns with ICM grade B was significantly higher than that of blastocysts with grade A[OR 95%CI:2.17(1.51,2.94),P<0.001],while the proportion of blastocysts with TE grade B and C was lower than that of blastocysts with grade A,and the corresponding OR(95%CI)was 0.56(0.38,0.78)and 0.35(0.22,0.55)respectively.In the FET cycle,the proportion of male newborns with TE grade B and C was significantly lower than that of blastocysts with grade A(P=0.001)and the corresponding OR(95%CI)was 0.78(0.54,1.10)and 0.53(0.36,0.78)respectively.Conclusion:Blastocyst with low morphological score does not increase the risk of poor perinatal outcome.Blastocysts with higher TE grade are more likely to receive male newborns after blastocyst transfer.In the fresh cycle,The proportion of male offspring from blastocysts of ICM grade B was significantly higher than that of grade A.

关 键 词：囊胚形态学 ICM TE 围产儿结局 性别比 

分 类 号：R715.2[医药卫生—妇产科学]