冻融周期不同发育速度囊胚移植的临床结局分析
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摘要
目的回顾性分析冻融周期中选择D5或D6囊胚解冻移植的妊娠结局。方法接受人类辅助生殖技术治疗的患者,新鲜取卵周期中D5和D6形成的可利用囊胚以玻璃化冷冻方法分别进行冷冻保存;在冻融周期,以排卵后或加用黄体酮第5天为移植窗,将囊胚以玻璃化解冻方法解冻复苏培养2h后植入患者子宫。分析D5和D6囊胚解冻移植后着床率、临床妊娠率、活产率及流产率等的差异。结果 D5囊胚和D6囊胚复苏后的存活率(99.03%VS99.65%)无显著差异;D5冻融囊胚移植的临床妊娠率(70.59%)、种植率(58.46%)和活产率(59.2%)则明显高于D6冻融囊胚移植的临床妊娠率(53.99%)、种植率(39.71%)和活产率(40.1%),差异具有显著性(P<0.05);而D5囊胚移植后的流产率(16.4%)显著低于D6囊胚移植(25.5%)(P<0.05)。结论选择D5囊胚移植能够提高冻融周期临床妊娠率、种植率及活产率,并降低胎儿流产率。
Objective:To retrospectively analyze the pregnancy outcome of frozen-thawed cycles using D5 blastocyst versus D6 blastocyst. Methods:The blastocysts developed on D5 or D6 in the fresh cycles were cryopreserved by vitrification method. In the frozen-thawed cycles,when the endometrium of the patient reached ≥7 mm,blastocysts were thawed and transfered on Day5 after ovulation or progesterone supplement. Thawed embryos were cultured for 2 h and then transfered into the uterus of patients.Implantation rate,clinical pregnancy rate,live birth rate and abortion rate were compared between D5-blastocyst-transfer group and D6-blastocys-transfer group. Results:No significant difference in the survival rate was found between D5 blastocysts and D6 blastocysts(99. 03% VS 99.65%). In D5-blastocyst-transfer group,the clinical pregnancy rate(70.59%),implantation rate(58.46%)and live birth rate(59.2%)were significantly higher than those in D6-blastocys-transfer group,which were53.99%,39.71% and 40.1% respectively(P<0.05). The abortion rate,however,significantly decreased in D5-blastocysttransfer group comparing to that in D6-blastocys-transfer group(16.4% VS 25.5%,P<0.05). Conclusion:Elective transfer of D5 blastocyst can improve the pregnancy outcome of frozen-thawed cycles.
Objective:To retrospectively analyze the pregnancy outcome of frozen-thawed cycles using D5 blastocyst versus D6 blastocyst. Methods:The blastocysts developed on D5 or D6 in the fresh cycles were cryopreserved by vitrification method. In the frozen-thawed cycles,when the endometrium of the patient reached ≥7 mm,blastocysts were thawed and transfered on Day5 after ovulation or progesterone supplement. Thawed embryos were cultured for 2 h and then transfered into the uterus of patients.Implantation rate,clinical pregnancy rate,live birth rate and abortion rate were compared between D5-blastocyst-transfer group and D6-blastocys-transfer group. Results:No significant difference in the survival rate was found between D5 blastocysts and D6 blastocysts(99. 03% VS 99.65%). In D5-blastocyst-transfer group,the clinical pregnancy rate(70.59%),implantation rate(58.46%)and live birth rate(59.2%)were significantly higher than those in D6-blastocys-transfer group,which were53.99%,39.71% and 40.1% respectively(P<0.05). The abortion rate,however,significantly decreased in D5-blastocysttransfer group comparing to that in D6-blastocys-transfer group(16.4% VS 25.5%,P<0.05). Conclusion:Elective transfer of D5 blastocyst can improve the pregnancy outcome of frozen-thawed cycles.
引文
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[15]Wang X,Zhen J,Sun Z,et al.Effects of fifth day(D5)or sixth day(D6)frozen-thawed blastocysts on neonatal outcomes[J]Zygote 2016;24:684-691.
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[17]李城,李梅,马水英,等.不同发育天数冻融单囊胚移植的临床结局比较[J].现代妇产科进展,2014,23(2):121-123.
[18]Vanderzwalmen P,Bertin G,Debauche C,et aL.Births after vitrification at morula and blastocyst stages:effect of artificial reduction of the blastocoelic cavity before vitrification[J].Hum Reprod,2002,17:744-751.
[2]Du T,Chen H,Fu R,et al.Comparison of ectopic pregnancy risk among transfers of embryos vitrified on day 3,day 5,and day 6[J]Fertil Steril 2017;108:108-116.
[3]Poulsen V,Ingerslev HJ,Kirkegaard K.Elective embryo transfers on Day 6 reduce implantation compared with transfers on Day 5[J]Hum Reprod 2017;32:1238-1243.
[4]Kaye L,Will EA,Bartolucci A,et al.Pregnancy rates for single embryo transfer(SET)of day 5 and day 6 blastocysts after cryopreservation by vitrification and slow freeze[J].J Assist Reprod Genet 2017;34:913-919.
[5]刘吉,胡煜,宫立国,等.D5和D6冻融囊胚移植的比较[J].中国优生与遗传杂志,2012,20(6):108-111.
[6]Yang H,Yang Q,Dai S,Li G,Jin H,Yao G,Sun Y.Comparison of differences in development potentials between frozen-thawed D5 and D6 blastocysts and their relationship with pregnancy outcomes[J].J Assist Reprod Genet 2016;33:865-872.
[7]Lucil F,et al.Live birth rate following frozen-thawed blastocyst transfer is higher with blastocysts expanded on Day 5 than on Day6[J].Human Reproduction,2018,33(3):390-398.
[8]Gardner DK,Lane M,Stevens J,et al.Blastocyst score affects implantation and pregnancy outcome:towards a single blastocyst transfer[J].Fertil Steril,2000,73(6):1155-1158.
[9]Weimar CHE,et al.Endometrial stromal cells of women with recurrent miscarriage fail to discriminate between high-and lowquality human embryos[J].PLoS One 2012;7:e41424.
[10]Rienzi L,et al.embryo and blastocyst cryopreservation in ART:systematic review and meta-analysis comparing slowfreezing versus vitrification to produce evidence for the development of global guidance[J].Hum Reprod Update 2017;23:139-155.
[11]方健叶,杨菁,尹太郎,等.囊胚玻璃化冻存前激光打孔对冻融后移植效果的影响[J].中国组织工程研究与临床康复,2011,15(31):5731-5734.
[12]Van Voorhis BJ,Dokras A.Delayed blastocyt transfer:is the window shutting?[J].Fertil Steril,2008,89:31-32.
[13]Kadar A,Agarwal A,Abdelrazik H,et al.Evaluation of post thaw DNA integrity of mouse blastocysts after ultrarapid and slow freezing[J].Fertil Steril,2009,91:2087-2094.
[14]Sesh KS,Athanasios S,Virginia NB,et al.The influence of delayed blastocyst formation on the outcome of frozen-thawed blastocyst transfer:a systematic review and meta-analysis[J].Hum Re-prod,2010,25(8):1906-1915.
[15]Wang X,Zhen J,Sun Z,et al.Effects of fifth day(D5)or sixth day(D6)frozen-thawed blastocysts on neonatal outcomes[J]Zygote 2016;24:684-691.
[16]Levens ED,Gustofson RL,Hennessy S,et aL.Implantation rate an pregnancy outcomes are significantly improved in cryopreserved blastocyst transfers when frozen at day 5 compared to day 6[J].Fertil Steril,2006,86:S256-S257.
[17]李城,李梅,马水英,等.不同发育天数冻融单囊胚移植的临床结局比较[J].现代妇产科进展,2014,23(2):121-123.
[18]Vanderzwalmen P,Bertin G,Debauche C,et aL.Births after vitrification at morula and blastocyst stages:effect of artificial reduction of the blastocoelic cavity before vitrification[J].Hum Reprod,2002,17:744-751.