胚胎卵裂球数及取卵后2天和3天冷冻对冻融胚胎移植临床结局的影响

摘要

目的：探讨胚胎卵裂球数及取卵后2天（D2）和3天（D3）冷冻对胚胎的复苏效果以及冻融胚胎移植（FET）临床结局的影响。方法：回顾性分析2010年1月-2012年5月行FET的417个周期的临床资料，分别按胚胎冷冻的时间（D2/D3）、卵裂球数、移植优质胚胎数进行分组，比较各组的胚胎复苏效果及临床结局。结果：D2≥4-细胞组的胚胎复苏率和卵裂球全存活率显著高于D2＜4-细胞组（89.35%vs.79.11%，42.01% vs.30.22%，P＜0.05）；D3≥6-细胞组的胚胎复苏率和卵裂球全存活率显著高于D3＜6-细胞组（86.52%vs.72.43%，41.13%vs.31.07%，P＜0.01）。D2组冷冻胚胎复苏后的优质胚胎率（56.84%）高于D3组（48.82%），但D3组FET临床妊娠率（38.52%）高于D2组（27.61%），差异均有统计学意义（P＜0.05），2组间胚胎复苏率和流产率差异无统计学意义（83.50%vs.79.44%，10.81%vs.10.09%，P＞0.05）。随着移植优质胚胎数的增加，临床妊娠率和多胎率增加，差异有统计学意义（P＜0.05）。结论：D2≥4-细胞和D3≥6-细胞的胚胎冻融效果较好，D3冷冻胚胎的FET临床结局优于D2冷冻胚胎。%Objective: To explore the impact of embryo blastomere number at cryopreservation, and different cryopreservation time on day 2 (D2) or day 3 (D3) after in vitro fertilization,on the clinical outcomes of the frozen-thawed embryo transfer (FET). Methods:This is a retrospective analysis on 417 FET cycles. The patients were respectively divided into different groups according to cryopreservation time after in vitro fertilization,embryo blastomere number and good-quality embryo number. The clinical outcomes of the embryo-transfer were compared. Results:The embryo survival rate and total blastomere survival rate in the group of the blastomere number exceeded 4-cells on D2 after frozen-thawed were significantly higher than those in the group of the blastomere number less than 4-cells(89.35%vs. 79.11%,42.01%vs. 30.22%respectively,P<0.05). Compared with the group of blastomere less than 6-cells on D3,the group of blastomere exceeded 6-cells on D3 had higher embryo survival rate and total blastomere survival rate(86.52%vs. 72.43%,41.13%vs. 31.07%, P<0.01). The good-quality embryo rate on D2(56.84%) was significantly higher than that on D3 (48.82%), while the clinical pregnancy rate on D3(38.52%) was significantly higher than that of D2 (27.61%). There was no significant difference in the embryo survival rate and abortion rate between D2 and D3 (83.50%vs. 79.44%, 10.81% vs. 10.09% ,P>0.05) after frozen-thawed embryo-transfer. More good-quality embryos were transferred,higher the clinical pregnancy rate and multiple pregnancy rate obtained(P<0.05). Conclusions:Cryopreservation of more than 4 blastomeres on D2 and more than 6 blastomeres on D3 could get better frozen-thawed effect. The clinical outcomes of D3 cryopreservation embryo after FET were superior to D2 embryo.