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| 第3天新鲜胚胎移植周期中卵裂球数目与助孕方式对妊娠结局的影响 |
| 胡婷婷1,2,胡益祥3,张颖4,印惠荣5,汪伟伟5,松迪5,林莎莎5,许亚军5,叶红5,杜惠5,胡元波5,蔡艳萍5,颜宏利5*,冯景6* |
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(1. 锦州医科大学研究生培养基地(上海交通大学附属第六人民医院南院), 上海 201406;
2. 同济大学附属上海市第四人民医院医学检验科, 上海 200434;
3. 上海交通大学医学院附属瑞金医院内分泌科, 上海 200025;
4. 海军军医大学(第二军医大学)第一附属医院信息科, 上海 200433;
5. 海军军医大学(第二军医大学)第一附属医院生殖医学中心, 上海 200433;
6. 香港中文大学(深圳)第二附属医院检验科, 深圳 518172
*通信作者) |
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| 摘要: |
| 目的 探讨第3天新鲜胚胎移植周期中卵裂球数目及助孕方式对妊娠结局的影响。方法 回顾性分析2012年1月至2020年8月海军军医大学（第二军医大学）第一附属医院生殖医学中心收治的首次接受胚胎移植、采用常规体外受精（IVF）或卵胞浆内单精子显微注射技术（ICSI）助孕、胚胎质量为Ⅰ级或Ⅱ级的患者资料。共1 788个第3天新鲜移植周期纳入研究，先分为单胚胎移植和双胚胎移植两大类，每类再根据卵裂球数目分为≤ 6个细胞组、7个细胞组、8个细胞组、9个细胞组、≥ 10个细胞组。在新鲜单胚胎移植周期中，≤ 6个细胞组36个（IVF 21个、ICSI 15个），7个细胞组53个（IVF 25个、ICSI 28个），8个细胞组204个（IVF 146个、ICSI 58个），9个细胞组36个（IVF 22个、ICSI 14个），≥ 10个细胞组50个（IVF 34个、ICSI 16个）；在新鲜双胚胎移植周期中，≤ 6个细胞组59个（IVF 27个、ICSI 32个），7个细胞组72个（IVF 48个、ICSI 24个），8个细胞组1 178个（IVF 820个、ICSI 358个），9个细胞组44个（IVF 24个、ICSI 20个），≥ 10个细胞组56个（IVF 24个、ICSI 32个）。比较各组的胚胎种植率、临床妊娠率、流产率和活产率。结果 在新鲜单胚胎移植周期中，8个细胞组的胚胎种植率、临床妊娠率高于≤ 6个细胞组、7个细胞组、9个细胞组、≥ 10个细胞组（均P<0.05），活产率高于≤ 6个细胞组、7个细胞组（均P<0.05），流产率与≤ 6个细胞组、7个细胞组、9个细胞组、≥ 10个细胞组比较差异无统计学意义（均P>0.05）；8个细胞组中ICSI助孕的胚胎移植后胚胎种植率、临床妊娠率、活产率均高于IVF助孕（均P<0.05），而≤ 6个细胞组、7个细胞组、9个细胞组、≥ 10个细胞组中IVF和ICSI 2种助孕方式的胚胎种植率、临床妊娠率、活产率差异均无统计学意义（均P>0.05）。在新鲜双胚胎移植周期中，8个细胞组的胚胎种植率、临床妊娠率、活产率均高于≤ 6个细胞组、7个细胞组、9个细胞组、≥ 10个细胞组（均P<0.05），流产率与≤ 6个细胞组、7个细胞组、≥ 10个细胞组比较差异无统计学意义（均P>0.05），但低于9个细胞组且差异有统计学意义（P<0.05）；≤ 6个细胞组ICSI助孕的胚胎移植后胚胎种植率、临床妊娠率、活产率均高于IVF助孕（均P<0.05），而7个细胞组、8个细胞组、9个细胞组、≥ 10个细胞组中IVF和ICSI 2种助孕方式的胚胎种植率、临床妊娠率、活产率差异均无统计学意义（均P>0.05）。结论 在第3天新鲜胚胎移植周期中，可首选8个细胞胚胎，其次是9个细胞胚胎、≥ 10个细胞胚胎、7个细胞胚胎、≤ 6个细胞胚胎；8个细胞胚胎在ICSI助孕方式下的胚胎种植率、临床妊娠率和活产率比IVF高，可以优先选择；对于一部分ICSI助孕患者在无其他优质胚胎情况下，移植≤ 6个细胞的胚胎也可以获得较好的妊娠结局。 |
| 关键词: 卵裂球数目 单胚胎移植 助孕方式 临床妊娠率 活产率 |
| DOI：10.16781/j.CN31-2187/R.20210704 |
| 投稿时间：2021-07-19修订日期：2022-03-07 |
| 基金项目:军队女性官兵生殖健康管理保障体系建立研究项目（19JSZ06）. |
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| Effect of blastomere number in fresh embryo transfer cycles on day 3 and assisted pregnancy methods on pregnancy outcomes |
| HU Tingting1,2,HU Yixiang3,ZHANG Ying4,YIN Huirong5,WANG Weiwei5,SONG Di5,LIN Shasha5,XU Yajun5,YE Hong5,DU Hui5,HU Yuanbo5,CAI Yanping5,YAN Hongli5*,FENG Jing6* |
(1. Graduate Training Base, Jinzhou Medical University (South Branch of the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University), Shanghai 201406, China;
2. Department of Clinical Laboratory, Shanghai Fourth People's Hospital Affiliated to Tongji University, Shanghai 200434, China;
3. Department of Endocrinology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
4. Department of Information, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China;
5. Department of Reproductive Medicine, The First Affiliated Hospital of Naval Medical University (Second Military Medical University), Shanghai 200433, China;
6. Department of Laboratory, The Second Affiliated Hospital of The Chinese University of Hong Kong (Shenzhen), Shenzhen 518172, Guangdong, China
*Corresponding authors) |
| Abstract: |
| Objective To investigate the effect of the blastomere number on the 3rd day of fresh embryo transfer cycles and assisted pregnancy methods on pregnancy outcomes. Methods The data of patients who received embryo transfer for the first time, assisted by conventional in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), whose embryo quality was gradeⅠor gradeⅡ, and who were admitted to Department of Reproductive Medicine, The First Affiliated Hospital of Naval Medical University (Second Military Medical University) from Jan. 2012 to Aug. 2020 were retrospectively analyzed. A total of 1 788 fresh transfer cycles on the 3rd day were included and divided into 2 categories:single embryo transfer and double embryo transfer, and each category was further divided into ≤ 6-cell group, 7-cell group, 8-cell group, 9-cell group, and ≥ 10-cell group according to the number of blastomeres. In the fresh single embryo transfer cycles, there were 36 in ≤ 6-cell group (IVF 21, ICSI 15), 53 in 7-cell group (IVF 25, ICSI 28), 204 in 8-cell group (IVF 146, ICSI 58), 36 in 9-cell group (IVF 22, ICSI 14), and 50 in ≥ 10-cell group (IVF 34, ICSI 16). In the fresh double embryo transfer cycles, there were 59 in ≤ 6-cell group (IVF 27, ICSI 32), 72 in 7-cell group (IVF 48, ICSI 24), 1 178 in 8-cell group (IVF 820, ICSI 358), 44 in 9-cell group (IVF 24, ICSI 20), and 56 in ≥ 10-cell group (IVF 24, ICSI 32). The implantation rate, clinical pregnancy rate, live birth rate, and abortion rate were compared. Results In the fresh single embryo transfer cycles, implantation rate and the clinical pregnancy rate in the 8-cell group were significantly higher than those in the ≤ 6-cell, 7-cell, 9-cell, or ≥ 10-cell groups (all P<0.05) and the live birth rate was significantly higher than those in the ≤ 6-cell or 7-cell groups (both P<0.05); there was no significant difference in the abortion rate between 8-cell group and ≤ 6-cell, 7-cell, 9-cell, or ≥ 10-cell groups (all P>0.05); the implantation rate, clinical pregnancy rate, and live birth rate after ICSI embryo transfer in the 8-cell group were significantly higher than those after IVF embryo transfer (all P<0.05), while there were no significant differences in the implantation rate, clinical pregnancy rate, or live birth rate between IVF and ICSI in the ≤ 6-cell, 7-cell, 9-cell, or ≥ 10-cell groups (all P>0.05). In the fresh double embryo transfer cycles, the implantation rate, clinical pregnancy rate, and live birth rate of the 8-cell group were significantly higher than those of the ≤ 6-cell, 7-cell, 9-cell, or ≥ 10-cell groups (all P<0.05), the abortion rate was not significantly different from those of the ≤ 6-cell, 7-cell, or ≥ 10-cell groups (all P>0.05), but was significantly lower than that of the 9-cell group (P<0.05); the implantation rate, clinical pregnancy rate, and the live birth rate after ICSI embryo transfer in the ≤ 6-cell group were significantly higher than those after IVF embryo transfer (all P<0.05), while there were no significant differences in the implantation rate, clinical pregnancy rate, or live birth rate between IVF and ICSI in the 7-cell, 8-cell, 9-cell, or ≥ 10-cell groups (all P>0.05). Conclusion On the 3rd day of fresh transfer cycles, 8-cell embryos are the first choice, followed by 9-cell, ≥ 10-cell, 7-cell, and ≤ 6-cell embryos. The implantation rate, clinical pregnancy rate, and live birth rate of 8-cell embryos with ICSI are higher than those with IVF, so ICSI can be selected preferentially. For some ICSI assisted pregnancy patients with no other high-quality embryos, transferring ≤ 6-cell embryos can also achieve good pregnancy outcomes. |
| Key words: number of blastomeres single embryo transfer assisted pregnancy clinical pregnancy rate live birth rate |
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