激光皱缩法在囊胚玻璃化冷冻中的应用价值

目的：探讨激光打孔使囊胚腔皱缩在体外受精周期囊胚玻璃化冷冻中的应用价值。方法：将常规取卵后第3日移植、冷冻后剩余的形态学评分较差的胚胎发育而来的囊胚，采用或不采用激光打孔使囊胚腔皱缩后冷冻。分析606例解冻囊胚周期，比较采用和未采用激光皱缩2种方法冻存囊胚的效率，分析激光皱缩在囊胚玻璃化冷冻中的价值。结果：激光皱缩组解冻247例，4例（1．62％）取消移植，移植243例；未皱缩组359例，24例（6．69％）取消移植，移植335例。移植患者的年龄、不孕原因、排卵日内膜厚度、平均移植胚胎数组间均无统计学差异（P〉0．05）。激光皱缩组冻融取消率和流产率均显著低于非皱缩组（P〈0．05），生化妊娠率（45．68％vs35．82％）、种植率（22．54％vs16．56％）和继续妊娠率（87．50％vs75．56％）显著高于非皱缩组（P〈0．05），临床妊娠率激光皱缩组略高于非皱缩组（32．92％Ⅷ26．87％），但无统计学差异（P〉0．05）。结论：囊胚冷冻前采用激光打孔皱缩可提高解冻后的胚胎存活率，并能显著降低流产率。

Application Value of Laser Drilling for Blastocoeles Shrinkage Prior to Blastocyst Vitrification in IVF Cycles

Objective： To explore the application value of laser drilling for blastocoeles shrinkage before blastocyst vitrification in in vitro fertilization （IVF） cycles. Methods： A total of 606 frozen-thawed blastocyst transfer cycles were collected. All the blastocysts were developed from day 3 embryos with low morphological scores. The application value of laser shrinkage in the blastocyst vitrification was analyzed. Results： There were 247 frozen-thawed cycles in laser shrinkage group, of which 4 cycles （1.62%） were cancelled for degeneration of the thawed blastocysts, and 243 cycles got embryos transfer. There were 359 cases in non-shrinkage group, 24 cases were cancelled （6.69%）, 335 cases got embryos transfer. There was no difference of the patients age, the cause of infertility, endometrium thickness on ovulation day, average number of the embryos transferred between the two groups. Cancellation rate and abortion rate of laser shrinkage were significantly lower than those in non-shrinkage group （P〈0.05）, biochemical pregnancy rate （45.68% vs 35.82%）, implantation rate （22.54% vs 16.56%） and ongoing pregnancy rate （87.50% vs 75.56%） were higher than those in non-shrinkage group （P〈0.05）, and clinical pregnancy rate was higher in shrinkage group than in non-shrinkage group （32.92% vs 26.87%）, with no significant difference （P〉0.05）. Conclusion： Adopting laser drilling for blastocoeles shrinkage before blastocyst vitrification can improve survival rate of frozen-thawed blastocysts, reduce abortion rate significantly.