冷冻胚胎复苏移植周期不同质量和发育速度的单囊胚移植的临床结局  

Clinical outcomes of single blastocyst transfer with different qualities and developmental speeds in frozen-thawed embryo transfer cycles

作　　者：李真[1] 王可欣 任炳楠 管一春[1] 王兴玲[1] 刘景[1] 于晓娜[1] LI Zhen;WANG Kexin;REN Bingnan;GUAN Yichun;WANG Xingling;LIU Jing;YU Xiaona(Department of Reproduction Medicine Center,the Third Affiliated Hospital,Zhengzhou University,Zhengzhou 450052)

机构地区：[1]郑州大学第三附属医院生殖医学中心,郑州450052

出　　处：《郑州大学学报（医学版）》2022年第5期722-726,共5页Journal of Zhengzhou University(Medical Sciences)

摘　　要：目的:探讨冷冻胚胎复苏移植周期中单囊胚移植时不同质量和发育速度囊胚的优先移植顺序。方法:对2015年9月至2019年12月期间就诊于郑州大学第三附属医院生殖医学中心的不孕症患者(7195个冷冻胚胎移植周期)的临床资料进行回顾性分析。根据移植囊胚质量和发育速度的不同分为4组:D5优质囊胚组(第1组)、D5非优质囊胚组(第2组)、D6优质囊胚组(第3组)、D6非优质囊胚组(第4组);选择第2组的4期囊胚为2B组,第3组4期囊胚内细胞团(ICM)或滋养外胚层细胞(TE)为A级的为3A组,ICM和TE均为B级的为3B组。比较各组患者的活产率、临床妊娠率、胚胎种植率、流产率、异位妊娠率和多胎妊娠率等临床结局。对4组临床结局进行Logistic回归分析。结果:与第1组比较,其他组临床妊娠率、胚胎种植率、活产率降低;与第2组比较,第3组的多胎妊娠率升高;与第2和3组比较,第4组的临床妊娠率、胚胎种植率、活产率降低(P<0.05)。排除女方年龄、不孕时间、BMI、基础卵泡刺激素、移植日子宫内膜厚度等混杂因素后,以第3组为参照,第1组的临床妊娠率、胚胎种植率和活产率增加[OR(95%CI)为1.409(1.210~1.640)、1.409(1.210~1.640)、1.200(1.024~1.406)];第2组的多胎妊娠率降低[OR(95%CI)为0.308(0.107~0.891)];第4组的临床妊娠率、胚胎种植率和活产率降低[OR(95%CI)为0.591(0.502~0.696)、0.591(0.502~0.696)、0.748(0.628~0.892)]。3A组的临床妊娠率、胚胎种植率、活产率和多胎妊娠率均高于2B组和3B组(P<0.05)。结论:冷冻胚胎复苏移植周期中单囊胚移植的推荐顺序为D5优质囊胚>D6优质囊胚(A级组)>D6优质囊胚(B级组)/D5非优质囊胚>D6非优质囊胚。Aim:To investigate the preferential transfer sequence of blastocysts with different qualities and different developmental speeds for single blastocyst transfer in frozen-thawed embryo transfer(FET)cycles.Methods:The clinical data of 7195 FET cycles from Department of Reproductive Medicine Center,the Third Affiliated Hospital of Zhengzhou University from September 2015 to December 2019 were retrospectively analyzed.The transferred blastocysts were divided into 4 Groups according to their quality and developmental speed:D5 high-quality blastocyst group(Group 1),D5 non-quality blastocyst group(Group 2),the D6 high-quality blastocyst group(Group 3),and the D6 non-quality blastocyst group(Group 4).The 4th blastocysts of group 2 were selected as Group 2B,the 4th blastocysts with grade A inner cell mass(ICM)or trophectodermal cells(TE)of Group 3 were selected as Group 3A,and the 4th blastocysts with grade B both for ICM and TE of Group 3 as Group 3B.The clinical outcomes such as live birth rate,clinical pregnancy rate,embryo implantation rate,abortion rate,ectopic pregnancy rate and multiple pregnancy rate were compared among the groups.Logistic regression analysis was performed on the clinical outcomes of the 4 groups.Results:Compared with Group 1,the clinical pregnancy rate,embryo implantation rate and live birth rate in Group 3 were decreased;Compared with Group 2,the multiple pregnancy rate of Group 3 increased;compared with Group 3,the Group 4 had lower clinical pregnancy rate,embryo implantation rate and live birth rate(P<0.05).After confounding factors such as the woman′s age,duration of infertility,BMI,basal follicle-stimulating hormone,and endometrial thickness on the date of transfer were excluded,with Group 3 as a reference,Group 1 had higher clinical pregnancy rate,embryo implantation rate,and live birth rate[OR(95%CI)were 1.409(1.210-1.640),1.409(1.210-1.640),and 1.200(1.024-1.406)];Group 2 had a reduced multiple pregnancy rate[OR(95%CI)were 0.308(0.107-0.891)];Group 4 had reduced clinical pregnancy rate,

关 键 词：冷冻胚胎移植 单囊胚移植 移植策略 临床妊娠 活产 

分 类 号：R711.6[医药卫生—妇产科学]