卵裂期胚胎不同解冻时间点对其囊胚培养及妊娠结局的影响

目的：探讨卵裂期冻融胚胎不同解冻时间点对囊胚培养后移植妊娠结局的影响。方法：回顾性分析2013-2016年在江门市中心医院行冻融胚胎囊胚培养477例患者共520周期的资料。依据胚胎复苏时间不同分为D2组（D2 15：00-16：00胚胎复苏）、D3组（D3 8：00-9：00胚胎复苏），2组均于D5、D6 8：00-9：00观察囊胚形成。D5：D2、D3组培养时间分别为65 h、48 h；D6：D2、D3组培养时间分别为89 h、72 h。结果：2组的囊胚形成率（48.10% vs. 46.59%）、优质囊胚率（39.70% vs. 34.22%）、临床妊娠率（70.08% vs. 69.48%）、生化妊娠率（7.48% vs. 7.98%）、胚胎种植率（55.93% vs. 58.06%），差异均无统计学意义（均P＞0.05）。优胚与非优胚在48 h、65 h囊胚形成率分别为30.37% vs. 13.28%、62.64% vs. 40.14%，差异有统计学意义（均P＜0.05）。优胚与非优胚在72 h、89 h囊胚形成率分别为32.32% vs. 27.59%、2.17% vs. 2.06%，差异无统计学意义（均P＞0.05）。不同培养时间移植周期的临床妊娠率、胚胎种植率：48 h组＞65 h组＞72 h组＞89 h组，而生化妊娠率：89 h组＞48 h组＞65 h组＞72 h组，但各组间比较差异均无统计学意义（均P＞0.05）。结论：冻融胚胎囊胚培养可以根据工作需要选择在D2 15：00-16：00或D3 8：00-9：00进行胚胎解冻复苏；在D2 15：00-16：00解冻复苏，多数在D5即可形成囊胚进行移植；在D3 8：00-9：00解冻复苏，优胚在D5或D6均有形成囊胚可能，而非优胚需要培养较长的时间在D6形成囊胚。

Pregnant Outcome of Different Blastocyst Culture Time after Thawing of Vitrificated Cleaved Embryos

Objective：To investigate the optimum blastocyst culture time after thawing of vitrificated cleaved embryos and its effect on pregnant outcome. Methods：477 patients conducting 520 cycles of blastocyst culture after thawing of vitrificated cleaved embryos were retrospectively analyzed. According to the blastocyst culture time after thawing, 520 cycles were grouped into two groups: Group D2 (the warming time: 15-16 o′clock in D2) and Group D3 (the warming time: 8-9 o′clock in D3). In both groups, blastocysts were observed on 8-9 o′clock in D5/D6. Therefore the culture times were 65 h in Group D2 and 48 h in Group D3 in D5, and 89 h and 72 h in D6. Results：There were no significant differences between Group D2 and Group D3 in the blastocyst formation rate (48.10% vs. 46.59%), good quality blastocyst formation rate (39.70% vs. 34.22%), clinical pregnancy rate (70.08% vs. 69.48%), biochemical pregnancy rate (7.48% vs. 7.98%) and implantation rate (55.93% vs. 58.06%) (P＞0.05). The blastocyst formation rates of good and non-good embryos were (30.37% vs. 13.28%) and (62.64% vs. 40.14%) in 48 h and 65 h, respectively (P＜0.05). However, the blastocyst formation rates of good and non-good embryos were (32.32% vs. 27.59%) and (2.17% vs. 2.06%) in 72 h and 89 h respectively (P＞0.05). The clinical pregnancy rates and implantation rates were showed: 48 h group＞65 h group＞72 h group＞89 h group, and the biochemical pregnancy rates were showed: 89 h group＞48 h group＞65 h group＞72 h group, although there were non-significant differences in those rates among groups (P＞0.05). Conclusions：We can warm the vitrificated cleaved embryos at 15-16 o′clock in D2 or at 8-9 o′clock in D3. Majority of formed blastocysts can be transplanted into uterus in D5, if the vitrificated cleaved embryos were warmed at 15-16 o′clock in D2. The blastocysts of good quality embryos can be formed in D5 or D6, however those non-quality embryos could spend more time to form blastocysts until D6.