早期卵裂:移植胚胎选择的一个重要评估指标

摘要

Objective To investigate the impact of early cleavage (EC) on the outcomes of in vitro fertilization-embryo transfer (IVF-ET) and assess whether EC can be used as an additional parameter for day-3 embryo selection.Methods This retrospective cohort study included 267 fresh IVF-ET cycles.The transplanted embryos were day-3 high-quality embryos.According to the number of EC embryos in the transplanted embryos,they were divided into three groups:group A (two EC embryos),group B (one EC embryo and one non-EC embryo) and group C (two non-EC embryos).The differences of biochemical pregnancy rate,implantation rate,clinical pregnancy rate,spontaneous abortion rate,fraternal twins rate and live-birth rate were compared among the three groups.Results 1) There was no significant difference among the three groups in clinical and in vitro fertilization characteristics [i.e..female age,male age,infertility duration,ovarian stimulation protocol,egg number,MⅡ egg number,fertilization rate,embryo quality and endometrial thickness on the day of human chorionic gonadotropin (hCG) injection] (P＞0.05).2) Compared with group B,group A had a lower biochemical pregnancy rate,and higher rates of implantation,clinical pregnancy and live-birth,but the differences were not statistically significant (P＞0.05).3) Compared with group C,group B had lower biochemical pregnancy rate and spontaneous abortion rate,and higher implantation rate,clinical pregnancy rate and live-birth rate,but the differences were not significant (P＞0.05).4) Compared with group C,the biochemical pregnancy rate and the spontaneous abortion rate in group A were lower but the implantation rate,the clinical pregnancy rate and the live-birth rate were higher,and the differences of biochemical pregnancy rate (1.3％ vs 8.6％,x2=4.665,P=0.031),implantation rate (42.3％ vs 31.7％,x2=4.315,P=0.038),clinical pregnancy rate (65.4％ vs 49.0％,x2=4.834,P=0.028) and live-birth rate (51.3％ vs 35.6％,x2=4.504,P=0.034) were statistically significant.Conclusion Transfer of EC day-3 high-quality embryos can achieve higher implantation rate,clinical pregnancy rate and live-birth rate.Therefore,EC can be used as an important evaluating indicator for embryo selection in day-3 transfer.%目的 探讨早期卵裂(EC)对常规新鲜体外受精-胚胎移植(IVF-ET)结局的影响,评估EC能否作为第3日移植胚胎选择的一个评估指标.方法 回顾性队列研究分析267个新鲜IVF-ET周期,移植胚胎均为第3日优质胚胎,根据移植胚胎中EC胚胎的数目分为A组(移植2枚EC胚胎)、B组(移植1枚EC胚胎+1枚非EC胚胎)和C组(移植2枚非EC胚胎).分析比较3组之间生化妊娠率、种植率、临床妊娠率、自然流产率、异卵双胎率和活产率的差异.结果 ①患者临床及IVF特征各项指标[女方年龄、男方年龄、不孕年限、促排卵方案、获卵数、MⅡ卵数、受精率、移植胚胎质量和人绒毛膜促性腺激素(hCG)扳机日子宫内膜厚度]3组间差异均无统计学意义(P＞0.05).②A组与B组相比,生化妊娠率较低,种植率、临床妊娠率、每移植周期活产率均较高,但差异均无统计学意义(P＞0.05).③B组与C组相比,生化妊娠率和自然流产率较低,种植率、临床妊娠率、每移植周期活产率均较高,但差异均无统计学意义(P＞0.05).④A组与C组相比,生化妊娠率和自然流产率较低,种植率、临床妊娠率、每移植周期活产率均较高,其中生化妊娠率(1.3％比8.6％,x2=4.665,P=0.031)、种植率(42.3％比31.7％,x2=4.315,P=0.038)、临床妊娠率(65.4％比49.0％,x2=4.834,P=0.028)和每移植周期活产率(51.3％比35.6％,x2=4.504,P=0.034)差异有统计学意义.结论 移植发生EC的第3日优质胚胎可以获得更高的种植率、临床妊娠率和活产率,因此EC应作为第3日移植胚胎选择的一个重要评估指标.