新鲜周期D3卵裂期胚胎细胞数对D5囊胚质量和临床结局的影响  

The impact of cell number of D3 cleavage-stage embryo on D5 blastocyst quality and clinical outcomes in fresh cycles

作　　者：徐何荣 端木家苗 李宏慧 黄巧云 王珊珊[1] XU He-rong;DUANMU Jia-miao;LI Hong-hui;HUANG Qiao-yun;WANG Shan-shan(Center for Reproductive Medicine and Obstetrics&Gynecdogy,Nanjing Drum Tower Hospital,Nanjing University Medical School,Nanjing 210008)

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》2025年第2期143-149,共7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)。

摘　　要：目的探讨新鲜周期D3卵裂期胚胎细胞数对D5囊胚发育结局和D5单囊胚移植(SBT)妊娠结局及围产结局的影响。方法回顾性分析2021年1月至2023年8月于我院生殖医学科行新鲜周期D5 SBT的1596例患者(共1596个周期)的临床资料。根据所移植囊胚的D3卵裂胚细胞数分为3组:A组(<8细胞,n=80)、B组(8~10细胞,n=1161)和C组(>10细胞,n=355),随访并分析各组的囊胚发育结局、临床妊娠率、流产率、活产率及新生儿结局等。又根据移植D5囊胚的质量分为3组:优质囊胚组[A、B、C组来源者分别记为A1(n=7)、B1(n=383)、C1(n=150)]、中等质量囊胚组[A、B、C组来源者分别记为A2(n=32)、B2(n=693)、C2(n=189)]和低质量囊胚组[A、B、C组来源者分别记为A3(n=41)、B3(n=85)、C3(n=16)],比较各组内不同细胞数来源的同等质量囊胚移植后的临床结局。结果(1)不同D3卵裂胚细胞数组间比较:A组、B组、C组3组间优质囊胚形成的比例(分别为8.75%、32.99%、42.25%)两两比较均具有显著性差异(P<0.05);A组的临床妊娠率(56.25%vs.71.06%、76.06%)及活产率(51.25%vs.63.91%、66.20%)均显著低于B组和C组(P<0.05),3组间异位妊娠率、流产率、单卵双胎率及新生儿结局比较均无显著性差异(P>0.05)。(2)不同细胞数来源的同等质量囊胚比较:来源于D3不同细胞数而质量相同的囊胚移植后临床妊娠率和活产率均无显著性差异(P>0.05)。结论新鲜周期中,D5优质囊胚比例与D3卵裂胚细胞数有关。D3发育较慢的囊胚移植后妊娠率及活产率偏低,在选择D5囊胚进行移植时,应谨慎对待D3发育迟缓的胚胎。但D3不同细胞数的胚胎在形成同等质量囊胚后进行移植,其临床结局并无显著差异。Objective:To investigate the impact of cell number of D3 cleavage-stage embryo on the developmental outcome of D5 blastocysts as well as pregnancy and perinatal outcomes of single blastocyst transfer(SBT)on D5.Methods:A retrospective analysis was conducted on clinical data of 1596 patients(1596 cycles)who underwent fresh cycle D5 SBT at the Reproductive Medicine Department of our Hospital from January 2021 to August 2023.The D3 embryos were divided into three groups based on cell number of D3 cleavage-stage embryo:group A(<8 cells,n=80),group B(8-10 cells,n=1161),and group C(>10 cells,n=355).The developmental outcome of blastocysts,clinical pregnancy rate,the miscarriage rate,live birth rate,and neonatal outcomes were followed up and analyzed in each group.Additionally,the transferred D5 blastocysts were divided into three groups according to their quality:high-quality blastocyst group[A1(n=7),B1(n=383),C1(n=150)from group A,B and C,respectively],medium-quality blastocyst group[A2(n=32),B2(n=693),C2(n=189)from group A,B and C,respectively],and low-quality blastocyst group[A3(n=41),B3(n=85),C3(n=16)from group A,B and C,respectively].The clinical outcomes of blastocysts from different cell number sources within each subgroup were compared.Results:The results of comparison among different D3 blastomere groups showed:significant differences in the proportion of high-quality blastocysts formed in groups A,B,and C(8.75%,32.99%,42.25%,respectively,P<0.05).The clinical pregnancy rate(56.25%vs.71.06%,76.06%,P<0.05)and live birth rate(51.25%vs.63.91%,66.20%,P<0.05)in group A were significantly lower than those in groups B and C(P<0.05).There were no significant differences in ectopic pregnancy rate,the miscarriage rate,monozygotic twin rate,and neonatal outcomes among the three groups(P>0.05).The results of comparison of equal quality blastocysts from different cell number sources showed that there were no significant differences in the pregnancy rate and live birth rate after transferring blastocysts with the same quality

关 键 词：单囊胚移植 卵裂胚细胞数 囊胚质量 临床妊娠 活产率 

分 类 号：R711.6[医药卫生—妇产科学]