卵裂期胚胎复苏后培养至囊胚移植对RIF患者妊娠结局的影响  

The impact of culturing thawed split embryos to blastocyst stage on pregnancy outcome in patients with recurrent implantation failure

作　　者：潘璠 端木家苗 徐何荣 王珊珊[1] PAN Fan;DUAN-MU Jia-miao;XU He-rong;WANG Shan-shan(Center for Reproductive Medicine and Obstetrics and Gynecology,Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing210008)

机构地区：[1]南京大学医学院附属鼓楼医院生殖医学和妇产医学中心,南京210008

出　　处：《生殖医学杂志》2024年第9期1165-1170,共6页Journal of Reproductive Medicine

基　　金：南京鼓楼医院临床研究专项资金培育项目(2021-LCYJ-PY-08);2021年生殖医学中青年医生研究项目(横向课题)。

摘　　要：目的探讨对于反复种植失败(RIF)的患者,解冻卵裂期胚胎继续培养至囊胚移植能否改善患者的妊娠结局。方法回顾性分析2015年1月至2022年12月在我院生殖医学科接受冻融胚胎移植(FET)治疗的587例RIF患者的临床资料,根据不同的胚胎移植方案分为3组:解冻卵裂期胚胎继续培养至囊胚移植的为A组(n=45),解冻卵裂期胚胎移植的为B组(n=299),解冻囊胚移植的为C组(n=243);同时,将C组按解冻的囊胚发育时期分为移植第5天囊胚组(C-D5组,n=183)和移植第6天囊胚组(C-D6组,n=60),比较各组HCG阳性率、种植率、临床妊娠率、流产率、活产率等妊娠结局以及平均孕周和新生儿出生体重。结果选择解冻卵裂期胚胎继续培养至囊胚移植方案的患者初始有56例,11例患者(19.64%)因囊胚培养失败而取消周期。妊娠结局比较中,与B组相比,A组和C组的HCG阳性率(62.22%、57.61%vs.45.15%)、种植率(49.12%、44.48%vs.33.07%)及活产率(48.89%、44.03%vs.33.78%)均显著升高(P<0.05),3组间的流产率无显著差异(P>0.05);与C-D6组相比,A组和C-D5组的种植率(49.12%、48.70%vs.29.33%)、临床妊娠率(57.78%、56.28%vs.38.33%)及活产率(48.89%、49.18%vs.28.33%)均显著升高(P<0.05)。新生儿出生情况比较,A组的新生儿出生体重显著高于B组和C组(P<0.05),3组间的平均孕周无显著差异(P>0.05);A组和C-D6组新生儿出生体重显著高于C-D5组(P<0.05)。结论解冻卵裂期胚胎继续培养至囊胚移植可能在一定程度上能够改善RIF患者的妊娠结局。在FET周期中,若患者有D5囊胚冻存,建议优先解冻移植;若无冻存D5囊胚,可以尝试解冻卵裂期胚胎继续培养囊胚后移植,以获得较好的临床结局。Objective:To investigate whether continuing the culture of thawed split embryos to the blastocyst stage can improve the pregnancy outcome in patients with recurrent implantation failure(RIF).Methods:A retrospective analysis was conducted on the clinical data of 587 patients with RIF who underwent frozen-thawed embryo transfer treatment in the Reproductive Medicine Department of Nanjing Drum Tower Hospital,Affiliated Hospital of Medical School,Nanjing University from January 2015 to December 2022.Among them,there were 45 patients who underwent continued blastocyst culture after thawing and cleavage embryo division(group A),299 who underwent thawed cleavage embryo transfer(group B),and 243 who underwent thawed blastocyst transfer(group C).Patients in group C were further divided into two subgroups based on the day of blastocyst formation as the Day 5 blastocyst transfer group(group C-D5,n=183)and the Day 6 blastocyst transfer group(group C-D6,n=60).The clinical outcomes including HCG positive rate,the implantation rate,clinical pregnancy rate,the miscarriage rate,live birth rate and so on,and average gestational age as well as birth weight of newborns were compared and analyzed among the groups.Results:Among the 56 patients who chose to continue culturing thawed blastocysts for embryo transfer,11 patients(19.64%)had their cycles canceled due to failed blastocyst culture.In terms of pregnancy outcomes,HCG positive rate(62.22%vs.45.15%,57.61%vs.45.15%),the implantation rate(49.12%vs.33.07%,44.48%vs.33.07%)and live birth rate(48.89%vs.33.78%,44.03%vs.33.78%)in group A and group C were significantly higher than those in Group B(P<0.05).There was no significant difference in the miscarriage rate among the three groups(P>0.05).The birth weight of newborns in group A was significantly higher than in group B and group C(P<0.05).The implantation rate(49.12%vs.29.33%,48.70%vs.29.33%),clinical pregnancy rate(57.78%vs.38.33%,56.28%vs.38.33%),and live birth rate(48.89%vs.28.33%,49.18%vs.28.33%)in group A and group C-D5 were sig

关 键 词：反复种植失败 冻融胚胎移植 囊胚培养 妊娠结局 

分 类 号：R711.6[医药卫生—妇产科学]