囊胚玻璃化冷冻保存时长对复苏移植临床结局的影响

目的研究使用开放式载体玻璃化冷冻保存囊胚的时长对复苏移植妊娠结局和新生儿结局的影响,探讨胚胎经过玻璃化冷冻并进行6年以上的长期保存是否对临床结局产生负面影响。方法回顾性分析2006年3月至2018年12月期间在我院生殖中心进行囊胚玻璃化冷冻复苏移植的2 643例患者的临床资料。按照胚胎玻璃化冷冻保存时长将其分为7组:≤1年,1~2年,2~3年,3~4年,4~5年,5~6年和≥6年,比较各组患者一般情况、临床结局、活产情况和单胎新生儿出生结局之间的差异,再使用二分类Logistic回归分析女性取卵年龄、移植年龄、胚胎冷冻保存时间、囊胚冷冻日期和囊胚级别对妊娠率和活产率的影响。结果各组患者取卵年龄、移植年龄、优胚率、复苏胚胎存活率、妊娠率和活产率组间差异有统计学意义(P<0.05)。各组平均移植胚胎数、D5胚胎比例、种植率、流产率、异位妊娠率、单胎率、出生男孩率、出生缺陷率、单胎出生体重、身长和孕天数均无统计学差异(P>0.05)。Logistic回归分析显示取卵年龄、移植年龄和冷冻保存时间对妊娠率无显著影响(P>0.05),取卵年龄和冷冻保存时长对活产率无显著影响(P>0.05),而增加移植D5胚胎和优质胚胎数量可以提高妊娠率和活产率(P<0.05),移植年龄的增加会降低活产率(P<0.05)。结论使用开放性载体玻璃化冷冻保存囊胚的时长对复苏后移植的妊娠结局和新生儿结局没有明显影响。囊胚经过玻璃化冷冻并进行6年以上长期冷冻保存,临床结局未产生明显负面影响。

Effect of cryopreservation duration on clinical outcomes of vitrified-warmed blastocyst transfer

Objective:To explore the effect of cryopreservation duration with open vitrification systems on clinical and neonatal outcomes of vitrified-warmed blastocyst transfer,and investigate whether long-term vitrification cryopreservation of embryos over 6 years has a negative effect on clinical outcome.Methods:The clinical data of 2643 patients who underwent virified-warmed blastocyst transfer in the reproductive center of our hospital from March 2006 to December 2018 were retrospectively analyzed.According to the cryopreservation duration,the patients were divided into seven groups:≤1 year,1-2 years,2-3 years,3-4 years,4-5 years,5-6 years and≥6 years.The difference for general condition,clinical outcome,live birth outcome and singleton newborn outcome were compared among the groups.Logistic regression analysis was used to analyze the effect of maternal age at oocyte retrieval,maternal age at embryo transfer,embryo cryopreservation time,blastocyst freezing date and blastocyst grade on pregnancy rates and live birth rates.Results:There were significant differences in the maternal age at oocyte retrieval and at embryo transfer,optimal embryo rate,survival rate after warming,pregnancy rate and live birth rate among the groups(P<0.05).There were no significant differences in the average number of embryos transferred,proportion of Day 5 embryos transferred,implantation rate,miscarriage rate,ectopic pregnancy rate,singleton birth rate,birth boy rate,deformity rate,singleton birth weight,body length and gestational days among the groups(P>0.05).Logistic regression analysis showed that maternal age at oocyte retrieval,maternal age at embryo transfer and embryo cryopreservation time had no significant effect on pregnancy rate(P>0.05),while maternal age at oocyte retrieval and embryo cryopreservation time had no significant effect on live birth rate(P>0.05).Increasing the number of Day 5 embryos or high-quality embryos transferred improved the pregnancy rate and live birth rate(P<0.05),while increasing the maternal age at embryo transfer reduced the live birth rate(P<0.05).Conclusions:Cryopreservation duration with open vitrification systems has no obvious effect on clinical and neonatal outcomes of vitrified-warmed blastocyst transfer.Cryopreservation of blastocysts over a period of 6 years does not adversely affect clinical outcomes.