冷冻胚胎解冻后质量对临床妊娠结局的影响

目的探讨胚胎解冻后损伤及过夜培养后生长情况对临床妊娠结局的影响。方法回顾性分析冻融胚胎移植周期303例,共349个周期。(1)根据所移植胚胎卵裂球的损伤程度,分为移植的胚胎均无损伤的完整组(A1,n=193)、全部移植的胚胎均有卵裂球损伤的损伤组(A2,n=30)和移植既有完整胚胎又有卵裂球损伤胚胎的损伤混合组(A3,n=126);(2)解冻后胚胎经过夜培养,所移植胚胎均有不同程度生长的定为生长组(B1,n=187),所移植胚胎均未见生长的未生长组(B2,n=46)和所移植胚胎既有生长的胚胎又含有未生长胚胎的生长混合组(B3,n=116);(3)在生长组及生长混合组中,有胚胎达到桑葚胚状态的桑葚胚组(C1,n=86),无胚胎生长到桑葚胚的无桑葚胚组(C2,n=217);比较各组之间的妊娠率、种植率、活产率、流产率之间的差别。结果解冻后完整组(A1)及损伤混合组(A3)妊娠率分别为45.08%、40.48%,均显著高于损伤组(A2)(20%)(P=0.01,0.036);完整组(A1)种植率(24.25%)显著高于损伤组(A2)(11.11%)(P=0.02),活产率及流产率相应组间比较无显著性差异(P0.05);解冻后经过夜培养,生长组(B1)妊娠率(47.06%)显著高于生长混合组(B3)(34.48%)(P=0.031),生长组(B1)种植率(26.34%)显著高于未生长组(B2)(17%)及生长混合组(B3)(16.16%)(P=0.049,0.002)。桑葚胚组(C1)的妊娠率、种植率均显著高于无桑葚胚组(C2)(54.65%vs.37.33%,28.28%vs.19.76%)(P=0.006,0.015)。结论胚胎解冻后胚胎的完整性对妊娠结局有利;胚胎解冻后经过夜培养,有卵裂球细胞生长的胚胎能够获得较高的种植率及妊娠率,且生长为桑葚胚者能够获得较高的妊娠结局。

Impact of embryo quality after frozen-thawed on outcome of embryo transfer

Objective： To analyze the impact of embryo quality after frozen-thawed on the outcome of frozen- thawed embryo transfer（FET） Methods： The data of 349 FET cycles were retrospective analyzed. The cycles were divided into 3 groups：All blastmeres transferred were intact in group A1 （n = 193）; all blastmeres transferred were partially damaged in group A2（n= 30）;and the blastmeres transferred included both intact and partially damaged in group A3 （n= 126）. According to whether or not the mitosis occurrence in culturing the embryo after frozen-thawed, the cycles were divided into three groups：the embryos continued to develop in group Bl（n=187）;the embryos did not continue to develop in group B2（n=46）;both kinds of embryos presented in group B3（n=116）. According to whether the embryos developed to morula,the cycles were divided into two groups：the embryos developed to morul in group C1（n=86）;the embryos did not develop to morul in group C2（n=217）. Results.. The pregnancy rate in group A1 （45.08 %） and group A3 （40.48 %） was significantly higher than that in group A2 （200/oo）（P = 0.01 and 0. 036 respectively）. The implantation rate in group A1 （24. 25%）was significantly higher than that in group A2（11. 11%）（P=0.02）. There were no significant differences in the live birth rate and miscarriage rate among groupA1,A2 and A3. The pregnancy rate in group B1 （47.06 %）was significantly higher than that in group B3 （34. 48 %）（P = 0. 031）. The implantation rate in group B1（26.34 %）was significantly higher than that in group B2（17%）or B3（16.16%）（P=0. 049 and 0. 002, respectively） . The pregnancy rate （54. 65% vs. 37.33%） and implantation rate （28.28% vs. 19.76%）in group C1 were significantly higher than those in group C2 （P =0.006 and 0.015, respectively）. Conclusions_. The integrity of the embryos after frozen-thawed is beneficial to pregnancy outcome. If the embryos are survival and resumption of cleavage during furt