摘要
目的探讨不同发育速度的胚胎移植对辅助生殖临床结局的影响。方法对2015年1月1日至2023年12月31日在海军军医大学第一附属医院生殖医学中心接受体外受精和卵胞质内单精子注射胚胎移植助孕治疗的女性患者的临床数据进行回顾性分析。共有1556个周期被纳入移植。第3天移植为A组,按胚胎发育至第3天的速度分为A1亚组(≤6个细胞阶段)、A2亚组(7~9个细胞卵裂胚阶段)、A3亚组(≥10个细胞卵裂胚阶段);第4天移植为B组,按胚胎发育至第4天的速度分为B1亚组(卵裂胚阶段)、B2亚组(1期、2期囊胚或融合阶段)、B3亚组(3期及以上囊胚阶段);第5天移植为C组,按胚胎发育至第5天的速度分为C1亚组(1期、2期囊胚或融合阶段)、C2亚组(4期或5期囊胚阶段)、C3亚组(6期囊胚阶段);第6天移植为D组,按胚胎发育至第6天的速度分为D1亚组(1期、2期囊胚或融合阶段)、D2亚组(5期或6期囊胚阶段)。统计各组的临床妊娠率和活产率。结果胚胎发育速度均较慢的A1、B1、C1、D1亚组临床妊娠率分别为23.7%、37.3%、26.9%、35.9%(P<0.05),活产率分别为16.4%、28.4%、19.2%、26.9%(P<0.05),B1亚组临床妊娠率和活产率均最高;胚胎发育速度均正常的A2、B2、C2、D2亚组临床妊娠率分别为58.0%、59.4%、62.2%、61.5%(P<0.05),活产率分别为47.5%、49.4%、53.8%、52.3%(P<0.05),C2亚组临床妊娠率和活产率均最高;胚胎发育速度均较快的A3、B3、C3亚组临床妊娠率分别为62.2%、64.6%、63.5%(P<0.05),活产率分别为52.2%、56.9%、54.1%(P<0.05),B3亚组临床妊娠率和活产率均最高。结论在第4天移植发育速度快的囊胚可能获得更好的发育潜能和临床结局。发育速度较慢的胚胎建议培养到第4天移植,发育速度正常的胚胎建议培养到第5天移植。
Objective To investigate the influence of different embryo development rates on the clinical outcomes of assisted reproductive technology(ART).Methods The clinical data of female patients who underwent in vitro fertilization and intracytoplasmic sperm injection embryo transfer in Reproductive Medicine Center of The First Affiliated Hospital of Naval Medical University from Jan.1,2015 to Dec.31,2023 were retrospectively analyzed.A total of 1556 cycles were included.Group A was transferred on day 3,and they were assigned to subgroups according to the embryo development rates until day 3:subgroup A1(≤6 cell stages),subgroup A2(7-9 cell cleavage stages),or subgroup A3(≥10 cell cleavage stages).Group B was transferred on day 4,and they were assigned to subgroups according to the embryo development rates until day 4:subgroup B1(cleavage stages),subgroup B2(1^(st) or 2^(nd) period blastocyst or morula stages),or subgroup B3(3rd period blastocyst or higher stages).Group C was transferred on day 5,and they were assigned to subgroups according to the embryo development rates until day 5:subgroup C1(1^(st) or 2^(nd) period blastocyst or morula stages),subgroup C2(4^(th) or 5^(th) period blastocyst stages),or subgroup C3(6^(th) period blastocyst stages).Group D was transferred on day 6,and they were assigned to subgroups according to the embryo development rates until day 6:subgroup D1(morula or 1^(st) or 2^(nd) period blastocyst stages),or subgroup D2(5^(th) or 6^(th) period blastocyst stages).The clinical pregnancy and live birth rates were calculated for each group.Results Pairwise comparisons of the subgroups A1,B1,C1 and D1,all with relatively slow development rates,showed that the clinical pregnancy rates were 23.7%,37.3%,26.9%and 35.9%,respectively(P<0.05),the live birth rates were 16.4%,28.4%,19.2%and 26.9%,respectively(P<0.05),and the clinical pregnancy rate and live birth rate were both the highest in the B1 group.Pairwise comparisons of the subgroups A2,B2,C2 and D2 with normal development rates,the clinical pregnancy rates were 58.0%,59.4%,62.2%and 61.5%,respectively(P<0.05),the live birth rates were 47.5%,49.4%,53.8%and 52.3%,respectively(P<0.05),and the clinical pregnancy rate and live birth rate were both the highest in the subgroup C2.Pairwise comparisons of the subgroups A3,B3 and C3 with relatively fast development rates showed that the clinical pregnancy rates were 62.2%,64.6%and 63.5%,respectively(P<0.05),the live birth rates were 52.2%,56.9%and 54.1%,respectively(P<0.05),and the clinical pregnancy rate and live birth rate were both the highest in the subgroup B3.Conclusion The 4^(th) day fast-developing blastocysts have better development potential and clinical outcomes.Embryos with slower development rate should be transferred on the 4^(th) day,and embryos with normal development rate are recommended to be cultured and transferred to the 5^(th) day.
作者
袁雪菲
颜宏利
汪伟伟
YUAN Xuefei;YAN Hongli;WANG Weiwei(Reproductive Medicine Center,The First Affiliated Hospital of Naval Medical University(Second Military Medical University),Shanghai 200433,China;Clinical Laboratory,South Campus of Shanghai East Hospital(East Hospital Affiliated to Tongji University),Shanghai 200120,China)
出处
《海军军医大学学报》
北大核心
2025年第9期1177-1182,共6页
Academic Journal of Naval Medical University
基金
军队女性官兵生殖健康管理保障体系建立研究项目(19JSZ06)。
关键词
胚胎移植
辅助生殖
发育速度
临床妊娠率
活产率
embryo transfer
assisted reproductive technology
development rates
clinical pregnancy rate
live birth rate
