卵裂期胚胎冻存及移植策略对解冻周期临床妊娠率和多胎率的影响  

Effect of cleavage stage embryo freezing and transfer strategy on pregnancy rate and multiple birth rate in frozen-thawed cycles

作　　者：张小霞 陈伟兰[2] 李涛[1] ZHANG Xiao-xia;CHEN-Wei-lan;LI Tao(Reproductive Center,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630;Department of Pharmacy,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630)

机构地区：[1]中山大学附属第三医院生殖医学中心,广州510630 [2]中山大学附属第三医院药学部,广州510630

出　　处：《生殖医学杂志》2023年第7期1003-1012,共10页Journal of Reproductive Medicine

基　　金：国家自然科学基金面上项目(82060176)。

摘　　要：目的探讨在目前冻融胚胎移植(FET)以单囊胚移植为主流的情况下,卵裂期胚胎(简称卵裂胚)的冻存与移植策略对FET周期临床妊娠率及多胎率的影响。方法回顾性分析2015年10月至2022年1月在我院生殖医学中心接受卵裂胚FET治疗的2544个周期的临床资料。按照胚胎培养情况分为两组:D3冷冻备份组(冷冻部分D3卵裂胚,作为囊胚培养的备份胚胎;n=941)和D3全胚冷冻组(D3卵裂胚全部冷冻,无囊胚培养;n=1603)。又根据移植复苏卵裂胚的数量和质量不同分为5组:移植两枚优胚(A组)、移植1枚优胚+1枚非优胚(B组)、移植两枚非优胚(C组)、移植1枚优胚(D组)、移植1枚非优胚(E组);每组再根据患者年龄不同分为≤35岁和>35岁组。比较各组患者的一般资料及临床结局(种植率、临床妊娠率及多胎妊娠率等)。结果(1)D3冷冻备份组和D3全胚冷冻组不同移植策略亚组间获卵数、D3胚冷冻数存在显著性差异(P<0.001)。D3冷冻备份组中A组临床妊娠率最高(54.2%),显著高于C组(P<0.05);D3全胚冷冻组中A组的临床妊娠率最高(41.8%),显著高于C、D、E组(P<0.05);D3冷冻备份组和D3全胚冷冻组中A、B、C组间多胎妊娠率比较无显著性差异(P>0.05),单胚胎移植组(D、E组)的多胎妊娠率均为0%。(2)D3冷冻备份组≤35岁患者中,A组的临床妊娠率(61.5%)显著高于C组和E组(P<0.05);A组的多胎率为35.3%,但与B、C组比较尚无显著性差异(P>0.05)。D3冷冻备份组>35岁患者中,A组的临床妊娠率最高(41.4%),但与其他各组尚无显著性差异(P>0.05);A、B、C组的多胎妊娠率亦无显著性差异(P>0.05)。(3)D3全胚冷冻组≤35岁患者中,A组的临床妊娠率(62.3%)显著高于其他各组(P<0.05);A组的多胎率为36.4%,但与B、C组尚无显著性差异(P>0.05)。D3全胚冷冻组>35岁患者中,A、B组的临床妊娠率(26.2%、27.3%)显著高于C、D、E组(P<0.05),A、B、C组间多胎妊娠率亦无显著性差异(P>0.05)。结论Objective:To investigate the impact of the cleavage stage embryos freezing and transfer strategy on the multiple birth rate and clinical pregnancy rate in the current situation where frozen-thawed embryo transfer(FET)with single blastocyst transfer was the mainstream.Methods:The clinical data of 2544 FET cycles with cleavage stage embryo transfer in the reproductive center of our hospital from October 2015 to January 2022 were retrospectively analyzed.According to the status of embryo culture,they were divided into two groups:the Day 3 freezing backup group(freezing a portion of Day 3 cleavage embryos as backup embryos for blastocyst culture,n=941)and the Day3 whole embryo freezing group(freezing all Day 3 cleavage embryos and no blastocyst culture,n=1603).Each group was further divided into five subgroups according to the number and quality of transferred cleavage embryos after thawed:two good-quality embryos(group A),one good-quality embryo plus one non-good-quality embryo(group B),two non-good-quality embryos(group C),one good-quality embryo(group D),and one non-good-quality embryo(group E).Each group was further divided into≤35-year-old and>35-year-old groups based on the age of the patients.The general condition,the clinical pregnancy outcome(implantation rate,clinical pregnancy rate and multiple pregnancy rate)were compared among the groups.Results:(1)The numbers of oocytes retrieved and Day 3 frozen embryos were significantly different between the Day 3 freezing backup group and the Day 3 whole embryo freezing group(P<0.001).In the Day 3 freezing backup group,the clinical pregnancy rate(54.2%)of group A was the highest,which was significantly higher than that in group C(P<0.05).In the Day 3 whole embryo freezing group,the clinical pregnancy rate in group A was the highest(41.8%),which was significantly higher than that in group C,D,and E(P<0.05).There was no significant difference in the multiple pregnancy rate between the Day 3 freezing backup group and the Day 3 whole embryo freezing group(P>0.05),whil

关 键 词：卵裂期胚胎 冻融胚胎移植 冷冻策略 临床妊娠率 多胎率 

分 类 号：R711.6[医药卫生—妇产科学]