摘要
目的研究冻融单囊胚移植周期中,胚胎发育速度对囊胚移植妊娠结局的影响。方法回顾性分析2017年1月至2022年5月在厦门大学附属妇女儿童医院生殖医学科首次进行冻融单囊胚移植患者的临床资料,共纳入1744个周期。根据囊胚形成时间分为3组:D5上午组(n=1482),D5下午组(n=174)和D6组(n=88);又按照女方年龄进行分组:≤35岁组(n=1557),>35~<40岁组(n=149)和≥40岁组(n=38)。分析不同年龄组中不同囊胚形成时间亚组的基础资料及妊娠结局,并结合囊胚形态学评分,分析不同囊胚形成时间各组中不同囊胚评级亚组的基础资料和妊娠结局;采用多因素Logistic回归分析临床妊娠的影响因素。结果≤35岁组中,D5上午组的HCG阳性率(78.33%vs.63.19%vs.60.00%)、临床妊娠率(59.34%vs.44.44%vs.42.86%)及活产率(50.27%vs.38.02%vs.25.81%)均显著高于D5下午组或D6组(P均<0.0167)。>35~<40岁组中,D5上午组的HCG阳性率(75.45%vs.38.46%vs.38.46%)、活产率(45.54%vs.9.52%vs.8.33%)显著高于D5下午组或D6组(P均<0.0167);D5上午组的流产率显著低于D6组(12.07%vs.75.00%,P<0.0167)。≥40岁组中不同发育速度囊胚移植的妊娠结局均无显著性差异(P均>0.05)。按照囊胚评级进行分层分析,结果显示D5上午组不同级别囊胚的临床妊娠率(62.12%vs.58.68%vs.50.58%)间存在显著性差异(P<0.05),D5下午组不同级别囊胚临床妊娠率(62.50%vs.53.03%vs.33.00%)间亦存在显著性差异(P<0.05);且临床妊娠率随着囊胚评级降低出现下降的趋势。结论囊胚发育速度可能是评估囊胚质量的重要指标,发育速度越快的囊胚其发育为优质囊胚的可能性越大。囊胚评级相同时,发育速度较快的胚胎具有更高的发育潜能,可以获得更好的妊娠结局。随着女方年龄的增长,囊胚发育速度对妊娠结局的影响越来越小,但仍需进一步扩大样本量进行更加深入的研究。
Objective:To study the effect of embryonic development speed on pregnancy outcomes of frozen-thawed single blastocyst transfer.Methods:The clinical data of the patients(1744 cycles)who underwent the first frozen-thawed single blastocyst transplantation in Women and Children’s Hospital Affiliated to Xiamen University from January 2017 to May 2022 were retrospectively analyzed.According to the time of blastocyst formation,the cycles were divided into three groups:Day 5 morning group(n=1482),Day 5 afternoon group(n=174)and Day 6 group(n=88).According to the female age,the cycles were divided into three groups:≤35 years old group(n=1557),>35 to<40 years old group(n=149),and≥40 years old group(n=38).The basic data and pregnancy outcomes of subgroups with different blastocyst formation time in different age groups were analyzed.The basic data and pregnancy outcomes of the subgroups with different blastocyst grading based on blastocyst morphology scores in different blastocyst formation time groups were also analyzed.Multiple logistic regression analysis was used to analyze the influencing factors of clinical pregnancy.Results:In the≤35 years old group,the positive HCG rate(78.33%vs.63.19%vs.60.00%),the clinical pregnancy rate(59.34%vs.44.44%vs.42.86%),the live birth rate(50.27%vs.38.02%vs.25.81%)in Day 5 morning group were significantly higher than Day 5 afternoon group or Day 6 group(all P<0.0167).In>35 to<40 years old group,HCG positive rate(75.45%vs.38.46%vs.38.46%)and live birth rate(45.54%vs.9.52%vs.8.33%)in Day 5 morning group were significantly higher than those in Day 5 afternoon group or Day 6 group(all P<0.0167).The abortion rate in Day 5 morning group was significantly lower than that in Day 6 group(12.07%vs.75.00%,P<0.0167).However,there was no significant difference in the clinical outcomes of different development speed in≥40 years old group(P>0.05).The results of stratified analysis according to blastocyst grading showed that there was significant differences in clinical pregnancy rate(62.12%vs.58.68%vs.50.58%,P<0.05)in the different gradings of blastocysts of Day 5 morning group.There was also significant differences in clinical pregnancy rate(62.50%vs.53.03%vs.33.00%,P<0.05)in the different gradings of blastocysts of Day 5 afternoon group.The clinical pregnancy rate showed a decreasing trend with decrease of the blastocyst grading.Conclusions:Blastocyst development speed may be an important indicator to evaluate the quality of blastocysts.The faster the development speed of a blastocyst,the greater the likelihood of it developing into a high-quality blastocyst.With the same blastocyst grading,the embryos with faster development speed had higher developmental potential and can achieve better pregnancy outcomes.The effect of blastocyst development speed on pregnancy outcome becomes less with the increase of female age.However,further expansion of the sample is still needed for further in-depth research.
作者
张庆
邱乒乒
纪红
石健
王龙梅
丁露
姜雨飞
陈荣卷
李萍
ZHANG Qing;QIU Ping-ping;JI Hong;SHI Jian;WANG Long-mei;DING Lu;JIANG Yu-fei;CHEN Rong-juan;LI Ping(Department of Reproductive Medicine,Women and Children’s Hospital Affiliated to Xiamen University,Xiamen 361005;Xiamen Key Laboratory of Reproduction and Genetics,Xiamen 361005)
出处
《生殖医学杂志》
CAS
2023年第8期1150-1157,共8页
Journal of Reproductive Medicine
关键词
单囊胚移植
胚胎发育速度
妊娠结局
形态学评分
冻胚移植周期
Single blastocyst transfer
Blastocyst development speed
Pregnancy outcomes
Morphology score
Frozen-thawed embryo transfer cycle
