玻璃化冻融胚胎过夜培养与妊娠结局的相关性研究

目的研究玻璃化冻融胚胎解冻后过夜培养与妊娠结局的相关性。方法回顾性分析2014年于哈尔滨医科大学附属第一医院生殖中心行冻融胚胎移植(frozen-thawed embryo transfer,FET)治疗的周期,共936例,依据胚胎移植前是否过夜培养,将其分为两组。A组为解冻后过夜培养移植组,共856例;B组为解冻当日移植组,共80例。依据过夜培养后胚胎是否生长,将A组继续分为A1组:全部胚胎均生长,共499例;A2组:部分胚胎生长,共301例;A3组:无胚胎生长,共56例。将A1组按移植胚胎个数分为Aa组:移植3个胚胎,共173例;Ab组:移植少于3个胚胎,共326例。比较各组患者年龄、内膜厚度、胚胎复苏率、临床妊娠率、种植率。结果 A组与B组临床妊娠率(35.86%、33.75%)和种植率(19.13%、13.95%)差异无统计学意义(P0.05)。A1组临床妊娠率和种植率(42.69%、24.03%)均高于A2(26.91%、12.94%)和A3组(23.21%、13.45%)(P0.05)。Aa、Ab组在临床妊娠率(41.62%、43.25%)和多胎率(26.38%、25.71%)方面差异无统计学意义(P0.05),Ab组较Aa组有更高的胚胎种植率(28.85%vs18.3%)和更低的3胎率(0.71%vs 5.88%)。结论过夜培养后继续生长的胚胎有更高的临床妊娠率与胚胎种植率,增加移植的胚胎个数不能改善临床妊娠结局。

Study on the correlation of vitrified post - thawed embryo culture overnight and pregnancy outcome

Objective To investigate the correlation of vitrified post-thawed embryo culture overnight and pregnancy outcome. Methods A total of 936 frozen-thawed embryo transfer( FET) cycles in the reproductive unit of the first affiliated hospital of Harbin medical university from January 2014 to December 2014 were analyzed retrospectively. Depending on their post-thawed culture period, they were divided into two groups, cultured 18~24 h before transfer selected as group A (n=856) and cultured 1~4 h before transfer selected as group B (n=80). According to whether or not embryos developed during the post–thawed culture overnight, group A was subdivided into three groups:all the embryos developed (group A1,n=499),some of the embryos developed (group A2,n=301) and none of the embryos developed (group A3,n=56). According to the number of the transferred embryos, group A1 was divided into two groups:three embryos transferred ( group Aa, n =173 ) and less than three embryos transferred ( group Ab, n = 326 ) . Ages, endometrium thickness, embryo anabiosis rate, clinical pregnancy rate, implantation rate of these groups were compared. Results The clinical pregnancy rate and implantation rate of group A (35. 86%,19. 13% ) were similar with group B (33. 75%,19. 35%). The clinical pregnancy rate and implantation rate of group A1(42. 69 %,24. 03 %) were higher than those of group A2 and group A3 (26. 91 %,12. 94 %;23. 21 %,13. 45 %),the differences were statistically significant(P<0. 05). The clinical pregnancy rate and multiple pregnancy rate of group Aa (41. 62 %,26. 38 %) were similar with those of group Ab (43. 25 %,25. 71 %). Meanwhile, the implantation rate of group Ab ( 28. 85 %) was higher than that of group Aa ( 18. 3 %) and triplet pregnancy rate of group Ab (0. 71 %) was lower than that of group Aa (5. 88 %), the differences were statistically significant(P <0. 05). Conclusion Embryos developed overnight have higher clinical pregnancy rate and implantation rate. Transfer more embryos can not improve the outcomes of FET.