体外受精治疗周期中剩余胚胎囊胚培养的临床价值

目的探讨体外受精治疗周期中d3移植和冷冻后剩余胚胎的体外发育潜能。方法对剩余胚胎继续培养至囊胚期，观察其囊胚发育率和质量，并分析治疗周期中剩余胚胎囊胚形成情况和妊娠结局的关系。结果收集115个IVF／ICSI-ET周期中的603枚剩余胚胎，囊胚培养后获得了222枚囊胚（36．82％），其中优质囊胚49枚（8．13％）；36个周期（31．30％）共获得53枚冷冻囊胚（8．79％）；12例含有剩余胚胎来源囊胚的解冻移植周期，临床妊娠4例；≥6细胞、2PN来源胚胎囊胚形成率显著高于其他组（P〈0．05）；剩余胚胎有囊胚形成的周期临床妊娠率显著高于无囊胚形成组（P〈0．05）。结论根据d3胚胎形态学评分预测其发育潜能有一定局限性；通过囊胚培养筛选出剩余胚胎中具有发育潜能的并冷冻保存，是提高病人每个治疗周期可用胚胎数的可行方法；剩余胚胎囊胚形成情况可有效预测妊娠结局。

Clinical value of extended culture to blastocyst stage of surplus embryos in in vitro fertilization treatment cycles

Objective To investigate the developmental potential of surplus embryos after embryo transfer or freezing at day 3. Methods The surplus embryos were extended culture to blastocyst to observe the blastocyst development rate and bIastocyst quality, and also the relationship between blastocyst formation and the pregnancy result was analyzed. Results In 115 IVF/ICSI-ET cycles, a total of 603 surplus embryos were extended culture to blastocyst, formed 222 blastulas （36. 82% ） among which 49 （8. 13% ） were high-quality blastulas;53 frozen hlastocysts （8.79%） were obtained from 36 cycles（31.30% ） ;4 of 12 FET cycles achieved clinical pregnancy by transferring the frozen hlastocysts formed of surplus embryos. ≥ 6 blastomeros embryos, 2PN embryos had a significant higher blastocyst development rate than other groups（P 〈0. 05） ;the blastocyst group had a significant higher clinical pregnancy rate than the group without blastocyst development（P 〈 0. 05 ）. Conclusion It had a limited value of morphological assessment at day 3 to predict the embryo developmental potential;It is a feasible method for increasing the number of available embryos in treatment cycles by blastocyst culture to select the potential embryos; The blastocyst development of surplus embryos could predict the pregnancy result.