[1]陈清汾,康跃凡,林典梁,等.D5、D6优质囊胚移植和冷冻策略研究*[J].陕西医学杂志,2019,(10):1263-1267，1396.
　CHEN Qingfen,KANG Yuefan,LIN Dianliang,et al.The strategies in cryopreservation and transfer of highquality blastocysts on Day5 and Day 6[J].,2019,(10):1263-1267，1396.
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D5、D6优质囊胚移植和冷冻策略研究*
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《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2019年10期
页码:
1263-1267，1396
栏目:
基础研究
出版日期:
2019-10-05

文章信息/Info

Title:
The strategies in cryopreservation and transfer of highquality blastocysts on Day5 and Day 6
文章编号:
DOI:10.3969/j.issn.10007377.2019.10.004
作者:
陈清汾; 康跃凡; 林典梁; 杜生荣
福建省妇幼保健院（福建医科大学附属医院）生殖医学中心（福州 350001）
Author(s):
CHEN Qingfen; KANG Yuefan; LIN Dianliang; et al.
Fujian Provincial Maternity 〖JZ〗and Children’s Hospital，Affiliated Hospital of Fujian Medical University(Fuzhou 350001)
关键词:
D5囊胚; D6囊胚; 妊娠结局; 冻融移植周期
Keywords:
Key words 〖WT5BZ〗〖HT5”SS〗Day 5 blastocyst; Day 6 blastocyst; Pregnancy outcome; Vitrified warmed transfer cycles
分类号:
R715
文献标志码:
A
摘要:
摘 要 目的：比较冻融移植周期中不同发育速度（D5或D6）的优质囊胚的妊娠结局，探讨不同发育速度的优质囊胚的移植和冷冻策略。 方法：收集行D5或D6冻融优质囊胚移植（≥1个）的周期1864个，女方取卵年龄均＜38岁。根据移植囊胚数、囊胚等级和囊胚的发育速度分为D5单优质囊胚组（D5SHBT，822个移植周期）、D5双优质囊胚组（D5DHBT，503个移植周期）、优和非优D5囊胚组（D5H & PBT，116个移植周期）、D6单优质囊胚组（D6SHBT，210个移植周期）、D6双优质囊胚组（D6DHBT，94个移植周期）、优和非优D6囊胚组（D6H & PBT，119个移植周期）；比较D5各组冻融囊胚移植周期的妊娠结局、D6各组冻融囊胚移植周期的妊娠结局及D5和D6单、双优质冻融囊胚移植周期的妊娠结局。结果：在D5冻融囊胚移植周期中，各组间流产率比较差异无统计学意义；D5DHBT临床妊娠率显著高于D5SHBT，D5H & PBT临床妊娠率与D5DHBT、D5SHBT比较差异均无统计学意义；D5SHBT种植率显著高于D5H & PBT，其余两组种植率比较差异均无统计学意义； D5DHBT和D5H & PBT多胎率均显著高于D5SHBT，D5DHBT和D5H & PBT多胎率比较差异无统计学意义；D5DHBT早产率均显著高于D5H & PBT和D5SHBT，D5H & PBT和D5SHBT早产率比较差异无统计学意义；D5DHBT活产率显著高于D5SHBT，其余两组组活产率比较差异无统计学意义。在D6冻融囊胚移植周期中，各组间种植率、流产率和早产率比较，差异均无统计学意义；临床妊娠率、多胎率和活产率组间比较，差异均具有统计学意义，其中D6DHBT和D6H & PBT的临床妊娠率、多胎率及活产率均显著高于D6SHBT，D6DHBT临床妊娠率、多胎率及活产率和D6H & PBT比较差异均无统计学意义。D5和D6单、双优质冻融囊胚移植周期中，各组间流产率比较，差异无统计学意义；而种植率、临床妊娠率、多胎率、早产率和活产率组间比较，差异均具有统计学意义，其中D5DHBT临床妊娠率和活产率均显著高于D6SHBT和D6DHBT；D5SHBT临床妊娠率和活产率均显著高于D6SHBT，但与D6DHBT比较差异无统计学意义；D5组种植率均显著高于D6组；双优质囊胚移植组多胎率均显著高于单优质囊胚移植组，D5DHBT多胎率显著高于D6DHBT；D6DHBT早产率显著高于D5SHBT，D5DHBT早产率显著高于D6SHBT。 结论：对女方年龄＜38岁患者可建议冷冻1～2管形态学评分最高的D5单囊胚用于优先移植，其余囊胚行优和非优组合冷冻的策略，在改善妊娠结局的同时可减少患者的胚胎冷冻和保管费用并减少冷冻所需空间；鉴于D6SHBT的妊娠结局并不理想，建议D6囊胚行双优质或优和非优组合冷冻及移植。
Abstract:
Abstract 〖WT5BZ〗〖HT5”SS〗Objective:The purpose of this study was to compare the pregnancy outcomes of highquality blastocysts cryopreserved during different developmental stages (frozenthawed day 5 \[D5\] and day 6 \[D6\] cycles).Our aim was to investigate the strategies into cryopreservation and transplantation of highquality blastocysts on day 5 and day 6.Methods:Retrospective analysis of the clinical data on 1864 frozenthawed highquality blastocyst transfer cycles among day 5 or day 6.The female were all younger than 38 years old.The cycles were stratified as single highquality blastocyst group of day 5(D5SHBT,n=822),high and poor quality blastocyst group of day 5(D5H & PBT〖JP〗〖LM〗,n=116) and double highquality blastocyst group of day 5(D5DHBT,n=503),according to the number of blastocyst transfer,the blastocyst grade and development speed.The pregnancy outcomes of frozenthawed blastocyst transfer cycles among day 5 were compared.Meanwhile,the frozenthawed highquality blastocyst transfer cycles among day 6 were also divided into single highquality blastocyst group of day 6(D6SHBT,n=210),high and poor quality blastocyst group of day 6(D5H & PBT,n=119) and double highquality blastocyst group of day 6(D6DHBT,n=94).The pregnancy outcome of each group was compared.Finally,we compared the pregnancy outcomes of single and double highquality blastocyst transfer cycles between day 5 and day 6.Results:There was no significant difference in the abortion rate among the frozenthawed blastocyst transfer cycles of day 5.The clinical pregnancy rate of the D5DHBT group was significantly higher than that of the D5SHBT group.However,the clinical pregnancy rates were not significantly different between the D5H & PBT group and the D5DHBT group,nor differ from the D5H & PBT group to the D5SHBT group.The implantation rate of the D5SHBT group was significantly higher than that of the D5H & PBT group,and there was no significant difference between the other two groups.The multiple pregnancy rates from the D5DHBT group and the D5H & PBT group were comparable to the D5SHBT group,while it did not significantly differ between the D5DHBT group and the D5H & PBT group .The preterm birth rate of the D5DHBT group was significantly higher than that of the D5 H&PBT group and the D5SHBT group ,and there was no significant difference between the D5H & PBT group and the D5SHBT group.The live birth rate of the D5DHBT was significantly higher than that of the D5SHBT group,and there was no significant difference between the other two groups.The implantation,abortion and preterm birth rate among the frozenthawed blastocyst transfer cycles of day 6 did not exhibit significant differences,but the clinical pregnancy,multiple pregnancy and preterm birth rates were comparable.The clinical pregnancy,multiple pregnancy and preterm birth rate of the D6SHBT group were significantly lower than those of the D6DHBT group and the D6H & PBT group,but the significant differences in those were not detected between the D6DHBT group and the D6H & PBT group.There was no significant difference among single or double highquality frozenthawed blastocyst transfer cycle in the abortion rate.However,the implantation,clinical pregnancy,multiple pregnancy,preterm birth and live birth rates were comparable.The clinical pregnancy and live birth rate of the D5DHBT group were significantly higher than that of the D6SHBT group and the D6DHBT group.Meanwhile,the clinical pregnancy and live birth rate of the D5SHBT group were significantly higher than that of the D6SHBT group,but was not significantly different from the D6DHBT group.The implantation rate of day 6 group was significantly lower than that of day 5 group.The multiple pregnancy rates in double highquality blastocyst transfer cycle groups were significantly higher than that in single highquality blastocyst transfer cycle groups.The multiple pregnancy rate of the D5DHBT group was significantly higher than that of the D6DHBT group.The premature delivery rate of the D6DHBT group was significantly higher than that of the D5SHBT group.The premature delivery rate of the D5DHBT group was significantly higher than that of the D6SHBT group.Conclusions:In women less than 38 years，it’s recommended that one to two tubes of single blastocyst on day 5 with the highest morphological score can be vitrified to transfer prior.The remaining blastocysts may be frozen with a method of highquality and poorquality combination to improve pregnancy outcomes while reducing the cost and the space required for embryo cryopreservation.Considering unsatisfactory pregnancy outcomes of the D6SHBT group,it’s recommended that D6 blastocysts should be treated with double highquality to cryopreserve and transfer or a highquality and a poorquality combined.

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备注/Memo

备注/Memo:
*福建省卫生计生青年科研课题（2018120）
更新日期/Last Update: 2019-10-23