冷冻时胚胎发育阶段对囊胚移植临床结局的影响  

The impact of embryonic developmental stage at cryopreservation on clinical outcomes of blastocyst transfer

作　　者：李甲楠[1] 张晓磊[1] 王秦[1] 张洪秀[1] 张雅娟[1] 刘美龄[1] 吴珩 卢美松[1] Li Jianan;Zhang Xiaolei;Wang Qin;Zhang Hongxiu;Zhang Yajuan;Liu Meiling;Wu Heng;Lu Meisong(Department of Reproductive Medicine,The First Affliated Hospital of Harbin Medical Medical University,Heilongjiang Harbin 150001,P.R.China)

机构地区：[1]哈尔滨医科大学附属第一医院生殖医学科,黑龙江哈150001

出　　处：《中国计划生育和妇产科》2024年第12期98-101,共4页Chinese Journal of Family Planning & Gynecotokology

基　　金：黑龙江省卫生健康委科研课题(项目编号:20230505030440);黑龙江省卫生健康委科研课题(项目编号:20230505030399)。

摘　　要：目的比较不同发育阶段冷冻的胚胎,解冻后培养至囊胚阶段移植的临床结局。方法回顾性分析2016年1月至2022年12月在哈尔滨医科大学附属第一医院生殖医学科行冷冻周期移植第5天优质囊胚的285例患者的临床资料。根据冷冻时胚胎发育的阶段不同,分为三组:A组为冻融第4天胚胎培养至囊胚阶段移植组(76例);B组为冻融第3天胚胎培养至囊胚阶段移植组(152例);C组为冻融第5天囊胚移植组(57例)。比较各组患者的基本资料及种植率、临床妊娠率、活产率、流产率、早期流产率。结果采用单因素方差分析比较3组间患者的基础资料,年龄、不孕年限和内膜厚度的差异均无统计学意义(P>0.05)。在3组患者移植胚胎数的比较中显示,A组(1.51±0.50)大于B组(1.36±0.48),B组大于C组(1.00±0.00),差异有统计学意义(P<0.05)。采用多因素回归分析,B组和A组、C组和A组间种植率、临床妊娠率、活产率、流产率的差异均无统计学意义(P>0.05)。A组(11.11%)与B组(16.04%)早期流产率比较,差异无统计学意义(P>0.05),而C组(25.00%)的早期流产率则显著高于A组(P<0.05)。结论第4天胚胎作为冷冻移植的新选择,冻融经囊胚培养后移植与第3天胚胎冻融囊胚培养后移植及直接移植冻融第5天囊胚在种植率、临床妊娠率、活产率、流产率方面可以取得相似的临床结局,可为冷冻周期中囊胚移植提供新策略。值得注意的是第5天冻融囊胚的早期流产率较高,对于早期流产风险因素较高的患者可优先考虑将第4天冻融胚胎培养至囊胚阶段再移植,有助于优化移植策略,减少早期流产的风险。Objective To compare the clinical outcomes of embryos frozen at different developmental stages and then thawed and cultured to the blastocyst stage for transfer.Methods A retrospective analysis was conducted on patients who underwent frozen embryo transfer cycles with high-quality day-5 blastocysts at the Reproductive Medicine Department of the First Hospital of Harbin Medical University from January 2016 to December 2022,encompassing 285 cases.Based on the developmental stage of the embryos at the time of freezing,they were divided into three groups:group A consisted of patients who had day-4 thawed embryos cultured to blastocyst stage for transfer(76 cases);group B consisted of patients who had day-3 thawed embryos cultured to blastocyst stage for transfer(152 cases);group C consisted of patients who had day-5 thawed blastocysts transferred(57 cases).The basic patient data,implantation rates,clinical pregnancy rates,live birth rates,miscarriage rates,and early miscarriage rates were compared among the groups.Results Univariate analysis of variance revealed no significant differences in age,duration of infertility,and endometrial thickness among the three groups(P>0.05).In the comparison of the number of embryos transferred among the three groups of patients,group A(1.51±0.50)was more than group B(1.36±0.48),and group B was more than group C(1.00±0.00),with the difference being statistically significant(P<0.05).Multifactorial regression analysis indicated no significant differences in implantation,clinical pregnancy,live birth,and miscarriage rates between group B and A,as well as C and A(P>0.05).The early miscarriage rate in group a(11.11%)was not significantly different from group B(16.04%)(P>0.05),while group C(25.00%)had a significantly higher rate of early miscarriage compared to group A(P<0.05).Conclusion Day-4 embryos provide a new option for frozen transfers,and transferring them after culturing to the blastocyst stage can achieve similar clinical outcomes regarding implantation rates,clinical pregnan

关 键 词：冻融胚胎 囊胚移植 第4天胚胎 临床结局 早期流产率 

分 类 号：R714.25[医药卫生—妇产科学]