解冻胚胎卵裂球损伤与胚胎发育潜能关系的研究

摘要

目的 探索解冻胚胎移植(frozen-thawed embryo transfer,FET)周期中胚胎卵裂球损伤与胚胎发育潜能的关系,为FET周期挑选合适移植胚胎提供依据.方法 回顾性分析2010年1月～2011年12月在第四军医大学西京医院妇产科生殖医学中心进行FET的患者病历,根据解冻后移植胚胎的卵裂球的完整程度分组:解冻后移植胚胎的卵裂球均完整,且卵裂球数＞4,碎片＜15％,为A组(完整组),共214例;解冻后胚胎均有卵裂球损伤,损伤卵裂球1～2个,并且至少仍有6个完整无损伤卵裂球,碎片＜15％,为B组(损伤组),共62例.计量资料组间比较采用t检验,计数资料组间比较采用x2检验以及Logistic回归方法进行分析.结果 A组与B组比较,年龄、体重指数、平均内膜厚度、移植胚胎数的差异无统计学意义(P＞0.05);A组的着床率和妊娠率均高于B组,流产率低于B组,两组比较差异有统计学意义(P =0.047);经Logistic回归分析,校正年龄、体重指数的影响后,B组的胚胎种植与临床妊娠情况仍低于A组,二者之间差异具有统计学意义(P＜0.05).结论 FET周期中胚胎卵裂球损伤影响胚胎后续发育潜能.%Objective To explore whether blastomere damage affects the ability of embryonic development in frozen-thawed embryo transfer (FET) cycles and to provide practical basis for selection of suitable embryos for transfer. Methods The clinical FET cases from Reproductive Medicine Center, Department of Gynecology & Obstetrics, Xijing Hospital of Fourth Military Medical University, between January 2010 and December 2011, were analyzed retrospectively. According to the integrity of blastomeres of transfer embryo after resuscitation, the cases were divided into integrity group (group A): the number of blastomeres of thawed embryos was more than 4 and the fragments were less than 15% (re = 214); partial damage group (group B): there were 1-2 damaged blastomeres within the thawed embryos and at least 6 complete blastomeres, and the fragments were less than 15% (n = 62). Differences in quantitative data were compared with t test. Enumeration data were compared with X2 test and logistic regression analysis. Results There were no significant differences in maternal age, body mass index, the average endometrial thickness, and the number of embryos per cycle between group A and group B (P>0.05). The implantation rate and pregnancy rate were higher in group A than in group B while the abortion rate was lower in group A than in group B, with significant differences (P = 0.047). Logistic regression analysis indicated that there was still a significantly negative correlation between blastomeres damage and clinical pregnancy outcomes after adjusting for the confounding factors (P<0.05). Conclusion Embryonic blastomeres damage can affect the potential of embryo development in the thawed embryo transfer cycles.