囊胚级别与发育速度对冻融移植周期临床结局的影响  

Influences of blastocyst grade and development speed on clinical outcomes of Frozen-thawed blastocyst transfer cycles

作　　者：刘锦 许世艳 宋丽杰 刘新琼 涂文娇 LIU Jin;XU Shiyan;SONG Lijie;LIU Xinqiong;TU Wenjiao(Shenzhen People's Hospital(The Second Clinical Medical College,Jinan University,The First Affiliated Hospital,Southern University of Science and Technology),Shenzhen 518020)

机构地区：[1]深圳市人民医院,暨南大学第二临床医学院/南方科技大学第一附属医院,518020

出　　处：《中国计划生育学杂志》2023年第1期125-129,共5页Chinese Journal of Family Planning

摘　　要：目的:比较第5天(D5)和第6天(D6)囊胚冻融移植后临床结局的差异。方法:回顾性分析1429个冻融单囊胚移植周期的临床资料,根据囊胚形态学评分和发育速度分为D5优质单囊胚组、D6优质单囊胚组、D5可利用单囊胚组和D6可利用单囊胚组,比较不同发育速度的囊胚移植后临床妊娠率、早期自然流产率及活产率。结果:移植优质单囊胚者,D5组临床妊娠率(67.0%)、活产率(57.3%)高于D6组(52.0%,40.3%),早期自然流产率(13.1%)低于D6组(19.1%)(P<0.05)。移植可利用单囊胚者,D5组临床妊娠率(44.7%)、活产率(34.3%)高于D6组(31.1%,20.9%)(P<0.05),但两组间早期自然流产率(13.7%,21.7%)无差异(P>0.05)。D6优质单囊胚组临床妊娠率、早期自然流产率、活产率与D5可利用单囊胚组无差异(P>0.05);logistic回归分析显示,囊胚发育速度缓慢是临床妊娠(OR=0.57)和早期自然流产(OR=1.76)的危险因素,优质的囊胚形态学评分则是临床妊娠的保护因素(OR=2.45)。结论:综合评估囊胚发育速度和形态学评分更利于临床结局评估,单囊胚移植优选顺序依次为D5优质囊胚、D6优质囊胚、D5可利用囊胚、D6可利用囊胚。Objective:To study the differences of blastocyst grade and development speed(D5 and D6)on the clinical outcomes of frozen-thawed blastocyst transfer cycles.Methods:The data of 1429 frozen-thawed blastocyst transfer cycles in Reproductive Medical Center of the Shenzhen people’s Hospital were analyzed in this retrospective cohort study.Patients were divided into four groups according to the blastocyst morphological score and development speed:D5 top-quality single blastocyst group、D6 top-quality single blastocyst group、D5 non-top quality single blastocyst group and D6 non-top quality single blastocyst group.The pregnancy outcomes were compared among four groups when the transferred blastocysts morphological score are fit well.Results:The clinical pregnancy rate(67.0%)and live birth rate(57.3%)of D5 group were higher than that of D6 group(52.0%,40.3%)for those who transferred top-quality single blastocyst patients;the early spontaneous abortion rate(13.1%)of D5 group was lower than that of D6 group(19.1%),and all of the differences were statistically significant(P<0.05).For those who transferred non-top quality single blastocyst patients,the clinical pregnancy rate(44.7%)and live birth rate(34.3%)of D5 group were better than that of D6 group(31.1%,20.9%),and there were significant statistically differences between groups.There was not significant difference in spontaneous abortion rate between two groups(13.7%vs 21.7%)(P>0.05).The clinical outcomes were better in D6 top-quality single blastocyst group than D5 non-top quality single blastocyst group but that didn’t reach statistical significance.Logistic regression analyses of the clinical data based on single blastocyst group indicated that slow blastocyst development speed was a risk factor for clinical pregnancy(OR=0.57)and early spontaneous abortion(OR=1.76).Blastocyst morphology score is an independent influencing factor of clinical pregnancy(OR=2.45).Conclusions:It is necessary to comprehensively evaluate the blastocyst development speed and morphologic

关 键 词：冻融囊胚移植 单囊胚移植 囊胚发育速度 临床妊娠率 早期自然流产率 

分 类 号：R714.8[医药卫生—妇产科学]