倪晓蓓，王珊珊，张宁媛，孙海翔

(南京大学医学院附属鼓楼医院生殖医学中心，江苏南京　210008)



·临床研究·

单囊胚冷冻复苏周期中囊胚时期及质量与临床结局相关分析

倪晓蓓，王珊珊，张宁媛，孙海翔*

(南京大学医学院附属鼓楼医院生殖医学中心，江苏南京210008)

目的比较囊胚时期及囊胚质量在单囊胚冷冻复苏周期中与临床结局的关系。方法回顾性分析2014年1 月至2015 年12月在本中心进行单囊胚冷冻复苏周期的患者，总例数为243例；分析研究囊胚时期及囊胚质量对临床结局的影响。结果囊胚时期及囊胚质量与临床结局有相关性：囊胚移植D5与D6植入率(61.14%vs.44.00%)和临床妊娠率(60.62%vs.44.00%)有显著性差异(P<0.05)；优质囊胚与非优质囊胚植入率(66.94%vs.47.90%)和临床妊娠率(66.94%vs.47.06%)亦有显著性差异(P<0.01)。患者的年龄、体重指数、基础激素水平、内膜厚度、流产率、异位妊娠率等均无统计学意义(P>0.05)。结论单囊胚冷冻复苏时可以优先考虑D5优质囊胚移植。

单囊胚冷冻复苏；囊胚时期；囊胚质量；临床结局

Methods：The data of 243 cryopreserved single blastocyst transfer cycles at the Reproductive Center from January 2014 to December 2015 were retrospectively analyzes. The clinical outcomes were compared among the blastocysts with different development periods and scoring parameters.

Results：Totally，the development periods & quality of blastocysts significantly impacted clinical pregnancy (P<0.05). The implantation rate(61.14% vs. 44.00%)and pregnancy rate (60.62% vs. 44.00%)of Day 5 and Day 6 blastocysts were significantly different (P<0.05). The implantation rate(66.94% vs. 47.90%)and pregnancy rate(66.94% vs. 47.06%)of high quality and non-quality blastocysts were also significantly different (P<0.01). There was no significance in age，body mass index，baseline hormone levels，endometrial thickness of the patients among the groups (P>0.05).

Conclusions：The transfer with high quality blastocysts on Day5 should be prioritized in cryopreserved single blastocyst transfer cycles.

(JReprodMed2016，25(10)：926-931)

随着胚胎培养技术的发展，囊胚培养的成功率得到改善，现已证实囊胚移植较卵裂期胚胎移植的临床妊娠率高[1-3]，Papanikolaou等[4]研究表明高评分的卵裂期胚胎培养至囊胚后移植相比高评分卵裂期胚胎移植组具有更好的妊娠率和活产率，近年来越来越多的辅助生殖中心开展单囊胚移植以期降低多胎率的同时维持可观的妊娠率。囊胚冷冻前的人工皱缩技术的发展使得冷冻复苏囊胚移植获得了与新鲜囊胚移植相似的活产率[5-6]，大大推进了囊胚冷冻复苏技术在辅助生殖技术中的应用，但是如何在冷冻复苏周期中挑选最佳发育潜能的囊胚还有待进一步研究。目前沿用的囊胚质量评分系统由Gardner等[7]提出，基于内细胞团、滋养外胚层形态和扩张等级三个参数。……