35周岁以下女性移植不同等级及不同发育速度冻融囊胚的临床结局

摘要

目的 探讨囊胚发育速度(D5或D6)分别对35周岁以下女性不同等级冻融囊胚(优质冻融囊胚或非优质冻融囊胚)发育潜能的预测价值. 方法 回顾性分析取卵年龄＜35岁,行D5或D6冻融囊胚移植的周期1 539个,根据移植囊胚数目和囊胚等级,单个优质冻融囊胚移植组(283个移植周期)、两个优质冻融囊胚移植组(838个移植周期)、单个非优质冻融囊胚移植组(194个移植周期)、两个非优质冻融囊胚移植组(224个移植周期).各组内再根据冷冻前形成的囊胚时间,分为D5组和D6组,比较各组内D5和D6冻融囊胚移植周期的妊娠结局. 结果 在单个非优质冻融囊胚移植中,D5组的临床妊娠率(46.88%)和种植率(46.88%)高于D6组(分别为33.08%和33.08%),但均无统计学差异(P均＞0.05);在两个非优质冻融囊胚移植周期中,D5组的种植率显著高于D6组(41.67% vs.31.01%,P＜0.05),临床妊娠率(54.54% vs.47.47%)和继续妊娠率(88.89% vs.76.00%)均高于D6组,早期流产率(11.11% vs.22.67%)低于D6组,但均无统计学差异(P均＞0.05);在单个优质冻融囊胚移植周期中,D5组的临床妊娠率(50.85% vs.52.83%)、种植率(51.41% vs.52.83%)、早期流产率(18.89% vs.17.86%)、继续妊娠率(80.00% vs.80.31%)与D6组比较均无统计学差异(P均＞0.05);在两个优质冻融囊胚移植周期中,D5组的临床妊娠率(78.40% vs.74.86%)、种植率(61.48% vs.59.38%)、早期流产率(7.90% vs.9.70%)、继续妊娠率(91.52% vs.88.06%)与D6组比较亦均无统计学差异(P均＞0.05). 结论 在35周岁以下的女性中,囊胚的发育速度对非优质冻融囊胚的发育潜能可能有着一定的预测价值,但是对于优质冻融囊胚发育潜能的预测价值不大.因此,在35周岁以下的冻融囊胚移植周期中,若无优质囊胚,可考虑优先选择D5非优质冻融囊胚移植.%Objective: To investigate the predictive value of development rate(Day 5 or Day 6) in the pregnancy outcomes of high-quality or poor-quality blastocyst transfer in frozen-thawed cycles for women less than age 35 years.Methods: The data of 1 539 frozen-thawed blastocyst transfer cycles of young women with age under 35 years were retrospectively analyzed.The cycles were divided into four groups according to the number and quality of blastocysts transferred:single high-quality(n=283) or double high-quality frozen-thawed blastocyst transfer(n=838),single poor-quality(n=194) or double poor-quality frozen-thawed blastocyst transfer(n=224).Each group was subdivided into Day 5 group and Day 6 group according to the time of blastocyst formation.The pregnancy outcomes were compared between the Day 5 and Day 6 frozen-thawed blastocysts among the four groups,respectively.Results: In single poor-quality frozen-thawed blastocyst(Day 5/Day 6) transfer cycles,the clinical pregnancy rate(46.88% vs.33.08%) and the implantation rate(46.88% vs.33.08%) in Day 5 group were higher than those in Day 6 group,but no significantly differences were observed(P＞0.05).In double poor-quality frozen-thawed blastocysts transfer cycles,the implantation rate(41.67% vs.31.01%) in Day 5 group was significantly higher than that in Day 6 group(P＜0.05).The clinic pregnancy rate(54.54% vs.47.47%) and the ongoing pregnancy rate(88.89% vs.76.00%) were higher and the early abortion rate(11.11% vs.22.67%)was lower in Day 5 group than Day 6 group,but no statistical significance were obtained(P＞0.05).In single high-quality frozen-thawed blastocyst transfer cycles,the clinical pregnancy rate(50.85% vs.52.83%),the implantation rate(51.41% vs.52.83%),the early abortion rate(18.89% vs.17.86%)and the ongoing pregnancy rate(80.00% vs.80.31%)were not significantly different between Day 5 group and Day 6 group(all P＞0.05).In double hight-quality frozen-thawed blastocysts transfer cycles,the clinical pregnancy rate(78.40% vs.74.86%),the implantation rate(61.48% vs.59.38%),the early abortion rate(7.90% vs.9.70%)and the ongoing pregnancy rate(91.52% vs.88.06%)were also not significantly different between Day 5 group and Day 6 group(all P＞0.05).Conclusions: The blastocyst development rate might have a role in predicting the embryo developing potential in poor-quality frozen-thawed blastocyst transfer cycles,while it might have no predictive value for the embryo developing potential of high-quality frozen-thawed blastocyst transfer in women less than age 35 years.Therefore,it might be considered a priority to take Day 5 poor-quality frozen-thawed blastocyst transfer in young patients if they have no high-quality frozen-thawed blastocysts.