囊胚发育速度及形态学评分对冻融胚胎移植周期单囊胚移植结局的影响
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摘要
目的比较囊胚发育速度及形态学评分对单囊胚冻融胚胎移植(FET)妊娠结局的影响。方法回顾性分析本中心行单囊胚移植的296例患者资料,根据囊胚发育速度(D5/D6)及ICM/TE形态学评分分为D5组、D6组,及优质囊胚组、非优质囊胚组(包括B/C、C/B两个亚组),比较不同组间妊娠结局,并采用回归分析方法探讨单囊胚FET妊娠结局的影响因素。结果移植优质囊胚者,D6组相对于D5组孕早期流产率稍高(10.3%vs.4.0%)、临床妊娠率稍高(59.2%vs.40.3%),但均无统计学差异(P>0.05);移植非优质囊胚者,D5组临床妊娠率稍高于D6组(45.6%vs.33.3%),但亦无统计学差异(P>0.05);ICM/TE评分为C/B的非优质囊胚组临床妊娠率显著低于优质囊胚组(33.3%vs.48.6%,P<0.05);Logistic回归分析发现临床妊娠率仅与囊胚内细胞团评分相关[OR=0.12,95%CI(0.03,0.56),P=0.007]。结论对于优质囊胚而言,囊胚发育速度对FET周期单囊胚移植结局影响不大;但对于非优质囊胚而言,在进行胚胎移植时,倾向于优先选择D5日内细胞团评分较高者。
Objective:To investigate the influence of blastocyst development time and morphological score on the pregnancy outcome of elective single blastocyst transfer in frozen cycles.Methods:The data of 296 patients who received single blastocyst transfer in FET cycles were retrospectively analyzed.The patients were grouped to Day 5 group,Day 6 group,good quality group,nongood quality group including B/C &C/B two subgroups scored by human blastocyst inner cell mass(ICM)and trophoblast cell(TE)staining method(ICM/TE),according to the blastocyst development day and morphological scores respectively.The pregnancy outcomes were compared among the groups.Regression analysis was used to investigate the influencing factors of pregnancy outcome in single blastocyst transfer of FET cycle.Results:For the patients received good-quality embryo transfer,the early abortion rate(10.3% vs.4.0%)and clinical pregnancy rate(59.2% vs.40.3%)in Day 6 group were higher than Day 5 group,but the differences were not significant(P >0.05).For the patients received non-good quality embryotransfers,the pregnancy rate in Day 5 group was higher than that in Day 6 group(45.6%vs.33.3%,P>0.05).Blastocysts with ICM/TE scored as C/B resulted in a significantly lower pregnancy rate compared with good-quality embryo group(33.3%vs.48.6%,P<0.05).The logistic regression analysis found that only the morphological score of ICM had a significant influence on the clinical pregnancy outcome[OR=0.12,95% CI(0.03,0.56),P=0.007].Conclusions:For good quality blastocysts,the blastocyst development time has little influence on the clinical pregnancy.However,for non-good quality blastocysts,the higher ICM score of Day 5 embryos are preferred for transplantation.
Objective:To investigate the influence of blastocyst development time and morphological score on the pregnancy outcome of elective single blastocyst transfer in frozen cycles.Methods:The data of 296 patients who received single blastocyst transfer in FET cycles were retrospectively analyzed.The patients were grouped to Day 5 group,Day 6 group,good quality group,nongood quality group including B/C &C/B two subgroups scored by human blastocyst inner cell mass(ICM)and trophoblast cell(TE)staining method(ICM/TE),according to the blastocyst development day and morphological scores respectively.The pregnancy outcomes were compared among the groups.Regression analysis was used to investigate the influencing factors of pregnancy outcome in single blastocyst transfer of FET cycle.Results:For the patients received good-quality embryo transfer,the early abortion rate(10.3% vs.4.0%)and clinical pregnancy rate(59.2% vs.40.3%)in Day 6 group were higher than Day 5 group,but the differences were not significant(P >0.05).For the patients received non-good quality embryotransfers,the pregnancy rate in Day 5 group was higher than that in Day 6 group(45.6%vs.33.3%,P>0.05).Blastocysts with ICM/TE scored as C/B resulted in a significantly lower pregnancy rate compared with good-quality embryo group(33.3%vs.48.6%,P<0.05).The logistic regression analysis found that only the morphological score of ICM had a significant influence on the clinical pregnancy outcome[OR=0.12,95% CI(0.03,0.56),P=0.007].Conclusions:For good quality blastocysts,the blastocyst development time has little influence on the clinical pregnancy.However,for non-good quality blastocysts,the higher ICM score of Day 5 embryos are preferred for transplantation.
引文
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[12]甄璟然,王雪,孙正怡,等.复苏单囊胚移植周期中囊胚形态学评分对临床妊娠的影响[J].生殖医学杂志,2014,23:7-10.
[13] Honnma H,Baba T,Sasaki M,et al.Trophectoderm morphology significantly affects the rates of ongoing pregnancy and miscarriage in frozen-thawed single-blastocyst transfer cycle in vitro fertilization[J].Fertil Steril,2012,98:361-367.
[14]陈清汾,林典梁,杜生荣.冻融周期非优质单囊胚移植妊娠结局的比较[J].国际生殖健康/计划生育杂志,2017,36:283-286.
[15] Hill MJ,Richter KS,Heitmann RJ,et al.Trophectoderm grade predicts outcomes of single-blastocyst transfers[J].Fertil Steril,2013,99:1283-1289.
[16] Minasi MG,Colasante A,Riccio T,et al.Correlation between aneuploidy,standard morphology evaluation and morphokinetic development in 1730biopsied blastocysts:a consecutive case series study[J].Hum Reprod,2016,31:2245-2254.
[17] Subira J,Craig J,Turner K,et al.Grade of the inner cell mass,but not trophectoderm,predicts live birth in fresh blastocyst single transfers[J].Hum Fertil(Camb),2016,19:254-261.
[2] Sundhararaj UM,Madne MV,Biliangady R,et al.Single blastocyst transfer:the key to reduce multiple pregnancy rates without compromising the live birth rate[J].J Hum Reprod Sci,2017,10:201-207.
[3] Devine K,Connell MT,Richter KS,et al.Single vitrified blastocyst transfer maximizes liveborn children per embryo while minimizing preterm birth[J].Fertil Steril,2015,103:1454-1460.
[4]魏明明,何玉洁.应用形态学及动力学参数筛选优质囊胚的研究进展[J].国际生殖健康/计划生育杂志,2016,35:308-312.
[5] Deniz FP,Encinas C,Fuente J.Morphological embryo selection:an elective single embryo transfer proposal[J].JBRA Assist Reprod,2018,22:20-25.
[6] Irani M,O’Neill C,Palermo GD,et al.Blastocyst development rate influences implantation and live birth rates of similarly graded euploid blastocysts[J].Fertil Steril,2018,110:95-102.
[7] Yang H,Yang Q,Dai S,et al.Comparison of differences in development potentials between frozen-thawed D5 and D6blastocysts and their relationship with pregnancy outcomes[J].J Assist Reprod Genet,2016,33:865-872.
[8] Kaing A,Kroener LL,Tassin R,et al.Earlier day of blastocyst development is predictive of embryonic euploidy across all ages:essential data for physician decision-making and counseling patients[J].J Assist Reprod Genet,2018,35:119-125.
[9]王雪,甄璟然,孙正怡,等.囊胚发育速度对冻融移植结局的影响[J].生殖医学杂志,2014,23:356-360.
[10]邱乒乒,王烨,纪红,等.冻融囊胚移植结局的影响因素分析[J].生殖医学杂志,2018,27:406-410.
[11] Thompson SM,Onwubalili N,Brown K,et al.Blastocyst expansion score and trophectoderm morphology strongly predict successful clinical pregnancy and live birth following elective single embryo blastocyst transfer(eSET):a national study[J].J Assist Reprod Genet,2013,30:1577-1581.
[12]甄璟然,王雪,孙正怡,等.复苏单囊胚移植周期中囊胚形态学评分对临床妊娠的影响[J].生殖医学杂志,2014,23:7-10.
[13] Honnma H,Baba T,Sasaki M,et al.Trophectoderm morphology significantly affects the rates of ongoing pregnancy and miscarriage in frozen-thawed single-blastocyst transfer cycle in vitro fertilization[J].Fertil Steril,2012,98:361-367.
[14]陈清汾,林典梁,杜生荣.冻融周期非优质单囊胚移植妊娠结局的比较[J].国际生殖健康/计划生育杂志,2017,36:283-286.
[15] Hill MJ,Richter KS,Heitmann RJ,et al.Trophectoderm grade predicts outcomes of single-blastocyst transfers[J].Fertil Steril,2013,99:1283-1289.
[16] Minasi MG,Colasante A,Riccio T,et al.Correlation between aneuploidy,standard morphology evaluation and morphokinetic development in 1730biopsied blastocysts:a consecutive case series study[J].Hum Reprod,2016,31:2245-2254.
[17] Subira J,Craig J,Turner K,et al.Grade of the inner cell mass,but not trophectoderm,predicts live birth in fresh blastocyst single transfers[J].Hum Fertil(Camb),2016,19:254-261.