不同胚胎发育速度对冻融单囊胚移植妊娠结局的影响.pdf

.1150生殖医学杂志2 0 2 3 年8 月第3 2 卷第8 期DO1:10.3969/j.issn.1004-3845.2023.08.003不同胚胎发育速度对冻融单囊胚移植妊娠结局的影响张庆1-2，邱乒乒1-2，纪红1-2，石健1-2，王龙梅1-2，丁露1-2，姜雨飞1-2，陈荣卷1-2，李萍1.2*（1.厦门大学附属妇女儿童医院生殖医学科，厦门3 6 10 0 5；2.厦门市生殖与遗传重点实验室，厦门3 6 10 0 5）【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2 0 17 年1月至2 0 2 2 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17 44个周期。根据囊胚形成时间分为3 组：D5上午组（n=1482），D 5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)，3 5 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3 5岁组中，D5上午组的HCG阳性率（7 8.3 3%vs6 3.19%v s.60.00%）、临床妊娠率（59.3 4%vs.44.44%vs.42.86%）及活产率（50.2 7%vs.38.02%vs.25.81%）均显著高于D5下午组或D6组（P均 3 5 40 岁组中,D5上午组的HCG阳性率（7 5.45%vS.38.46%vs，3 8.46%）、活产率（45.54%v s.9.52%v s.8.3 3%）显著高于D5下午组或D6组（P均 0.0 16 7);D5上午组的流产率显著低于D6组（12.0 7%vs.75.00%,P 0.0 5）。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（6 2.12%vs.58.68%vs.50.58%）间存在显著性差异（P0.05）,D 5下午组不同级别囊胚临床妊娠率（6 2.50%vs.53.03%vs.33.00%)间亦存在显著性差异（P0.05)；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。【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【中图分类号】R711.6Effect of different embryonic development speed on pregnancy outcomes of frozen-thawed single blastocyst transferZHANGQingl*2,QIU Ping-pingl*,JI Hong*,SHI Jian-2,WANG Long-meil-2,DING Lul-,JIANGYu-feil*,CHEN Rong-juan l-2,LI Ping l.2.1.Department of Reproductive Medicine,Women and Children s Hospital Affiliated to XiamenUniversity,Xiamen3610052.Xiamen Key Laboratory of Reproduction and Genetics,Xiamen 361005Objective:To study the effect of embryonic development speed on pregnancy outcomes of frozen-thawed single blastocyst transfer.Methods:The clinical data of the patients(1 744 cycles)who underwent the first frozen-thawed singleblastocyst transplantation in Women and Childrens Hospital Affiliated to Xiamen University from January2017 to May 2022 were retrospectively analyzed.According to the time of blastocyst formation,the cycleswere divided into three groups:Day 5 morning group(n=1 482),Day 5 afternoon group(n=174)and Day 6group(n=88).According to the female age,the cycles were divided into three groups:35 to 40 years old group(n=149),and 40 years old group(n=38).The basic data andpregnancy outcomes of subgroups with different blastocyst formation time in different age groups wereanalyzed.The basic data and pregnancy outcomes of the subgroups with different blastocyst grading basedon blastocyst morphology scores in different blastocyst formation time groups were also analyzed.Multiplelogistic 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%),theclinical 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(allP35 to 40 years old group,HCG positive rate(75.45%vs.38.46%vs.38.46%)andlive birth rate(45.54%vs.9.52%vs.8.33%)in Day 5 morning group were significantly higher than thosein Day 5 afternoon group or Day 6 group(all P0.016 7).The abortion rate in Day 5 morning group wassignificantly lower than that in Day 6 group(12.07%vs.75.00%,P0.05).The results of stratified analysis according to blastocyst grading showed that there was significantdifferences in clinical pregnancy rate(62.12%vs.58.68%vs.50.58%,P0.05)in the different gradingsof blastocysts of Day 5 morning group.There was also significant differences in clinical pregnancy rate(62.50%vs.53.03%vs.33.00%,P0.05)in the different gradings of blastocysts of Day 5 afternoongroup.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 ofblastocysts.The faster the development speed of a blastocyst,the greater the likelihood of it developinginto a high-quality blastocyst.With the same blastocyst grading,the embryos with faster developmentspeed had higher developmental potential and can achieve better pregnancy outcomes.The effect ofblastocyst 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.Key words:Single blastocyst transfer;Blastocyst development speed;Pregnancy outcomes;Morphology score;Frozen-thawed embryo transfer cycle:1151(JReprodMed2023,32(08)1150-1157)多胎妊娠是辅助生殖技术（ART)治疗的一种严重并发症。随着ART技术的进步，在提高妊娠率的同时，降低多胎率已成为临床工作者呕需解决的问题。而挑选出最具发育潜能的囊胚进行单囊胚移植，可以在保证妊娠的同时降低多胎的风险。形态学评分是目前应用最为普遍的囊胚评级方法。通过囊胚的外滋养层细胞和内细胞团的形态学评分可以对其发育潜能进行筛选。但是胚胎发育是多阶段的过程，因此仅通过囊胚期的形态学评价对其发育潜能进行评估尚不够准确。国内外已有很多的研究表明囊胚发育天数与囊胚移植的妊娠结局具有相关性，但是结果尚存在争议1-3 。目前研究的焦点多集中在囊胚发育天数是否对其妊娠结局有影响；其次是在选择囊胚移植时，不同发育天数和囊胚的形态学评级两者如何进行执择。本中心为了尽早将完全扩张的囊胚进行冷冻，增加了第5天（D5）下午的囊胚观察时点。本研究通过回顾性分析，研究D5上午、D5下午及D6不同发育速度的囊胚移植后妊娠结局的差异，探讨囊胚发育速度和级别对临床妊娠率的影响，以期进一步优化临床实践中胚胎筛选方法，提高临床妊娠率，改善妊娠结局。资料与方法一、研究对象选择2 0