囊胚的发育天数及质量对冻融周期单囊胚移植的临床结局影响  

Effect of blastocyst at different developmental stages and quality on the clinical outcomes of single blastocyst transfer in frozen-thawed cycles

作　　者：颜秋霞[1] 周秀琴[1] 乔静 赵晓英[1] 冯玲 朱振杰[1] 张国志 胡鸿 陈彩蓉[1] Yan Qiuxia;Zhou Xiuqin;Qiao Jing;Zhao Xiaoying;Feng Ling;Zhu Zhenjie;Zhang Guozhi;Hu Hong;Chen Cairong(Center for Reproductive Medicine,the Sixth Affiliated Hospital of Guangzhou Medical University Qingyuan People's Hospital,Qingyuan 511518,China)

机构地区：[1]广州医科大学附属第六医院,清远市人民医院生殖医学中心,清远511518

出　　处：《中华生殖与避孕杂志》2023年第10期1004-1011,共8页Chinese Journal of Reproduction and Contraception

基　　金：国家自然科学基金青年基金(82002671);广东省基础与应用基础研究基金(2019A1515010249);清远市科技计划项目(2020KJJH023);广州医科大学附属第六医院清远市人民医院开放课题基金(202301-306)。

摘　　要：目的探讨囊胚的发育天数及质量对冻融周期单囊胚移植的临床结局影响,为冻融周期单囊胚移植的选择策略提供依据。方法回顾性队列研究分析2013年1月至2021年6月期间在清远市人民医院生殖医学中心进行单囊胚解冻移植治疗的患者资料,共893个周期。根据囊胚发育天数分为第5天(day 5,D5)组和第6天(day 6,D6)组,再根据囊胚质量分为四个亚组,分别为D5优质胚胎亚组(n=423)、D5非优质胚胎亚组(n=129)、D6优质胚胎亚组(n=196)、D6非优质胚胎亚组(n=145),比较各组的一般资料、临床结局和新生儿结局。结果①D5组的临床妊娠率[60.14%(332/552)]、着床率[60.14%(332/552)]和活产率[47.64%(263/552)]均显著高于D6组[45.75%(156/341)、45.75%(156/341)、36.36%(124/341),均P<0.001],但两组的女方体质量指数、不孕年限、移植日内膜厚度和流产率差异均无统计学意义(均P>0.05),此外,两组的新生儿出生体质量、低出生体质量发生率、巨大儿发生率和男女性别比等新生儿出生结局差异均无统计学意义(均P>0.05)。②D5优质胚胎亚组、D5非优质胚胎亚组、D6优质胚胎亚组、D6非优质胚胎亚组的临床妊娠率分别为61.00%(294/482)、54.29%(38/70)、51.00%(127/249)、31.52%(29/92),活产率分别为48.96%(236/482)、38.57%(27/70)、41.37%(103/249)、22.83%(21/92),组间差异均有统计学意义(均P<0.001),D5优质胚胎亚组的临床妊娠率和活产率最高,D6非优质胚胎组的临床妊娠率和活产率最低。四个亚组的新生儿出生体质量、巨大儿发生率和男女性别比等新生儿出生结局差异均无统计学意义(均P>0.05),而低出生体质量发生率分别为5.08%(12/236)、0(0/27)、4.85%(5/103)、23.81%(5/21),差异有统计学意义(P=0.014)。③D5非优质胚胎亚组的临床妊娠率和活产率与D6优质胚胎亚组比较差异均无统计学意义(均P>0.05),进一步比较两亚组中不同级别的囊胚,D5非优质胚胎亚组的4BC临床妊娠�Objective To explore the effect of the developmental stages and quality on pregnancy outcome and birth outcome,and provide evidence for single blastocyst selection in frozen-thawed cycles.Methods A retrospective cohort study analysis was performed on the data of patients with a total of 893 cycles who underwent single blastocyst transfer in frozen-thawed cycles in the Center for Reproductive Medicine,Qingyuan People's Hospital from January 2013 to June 2021.The cycles were divided into day 5(D5)and day 6(D6)groups according to the time of blastocyst formation.Then the two groups were divided into four subgroups according to the quality of blastocyst,namely,D5 good-quality embryo subgroup,D5 non-good-quality embryo subgroup,D6 good-quality embryo subgroup and D6 non-good-quality embryo subgroup.The general data,clinical outcomes and neonatal outcomes of each group were compared.Results 1)The clinical pregnancy rate[60.14%(332/552)],the implantation rate[60.14%(332/552)]and the live birth rate[47.64%(263/552)]in D5 group were significantly higher than those in D6 group[45.75%(156/341),45.75%(156/341),36.36%(124/341),all P<0.001],but there were no significant differences in body mass index,duration of infertility,intimal thickness of transplantation day and miscarriage rate between the two groups(all P>0.05).In addition,there were also no significant differences in birth weight,low birth weight rate,fetal macrosomia rate and male/female ratio(all P>0.05).2)There were significant differences in clinical pregnancy rate[61.00%(294/482),54.29%(38/70),51.00%(127/249),31.52%(29/92)]and live birth rate[48.96%(236/482),38.57%(27/70),41.37%(103/249),22.83%(21/92)]among D5 good-quality embryo subgroup,D5 non-good-quality embryo subgroup,D6 good-quality embryo subgroup and D6 non-good-quality embryo subgroup(all P<0.001).D5 good-quality embryo subgroup had the highest clinical pregnancy rate and live birth rate,while D6 non-good-quality embryo subgroup had the lowest clinical pregnancy rate and live birth rate.There were also

关 键 词：单囊胚移植 冻融周期 囊胚质量 临床妊娠率 活产率 

分 类 号：R714.8[医药卫生—妇产科学]