摘要： 目的 探讨冻融优质单囊胚移植中，囊胚发育速度、内细胞团（ICM）评级、滋养外胚层（TE）评级对妊娠和新生儿结局的影响。方法 将938个冻融优质单囊胚移植周期按照囊胚形成时间分为D5组（在受精后第5天形成囊胚，n=653）和D6组（在受精后第6天形成囊胚，n=285）；根据TE评级分为TE-A组（n=371）和TE-B组（n=567）；根据ICM评级分为ICM-A组（n=607）和ICM-B组（n=331）。比较各组妊娠和新生儿结局，对影响临床妊娠率和活产率的因素进行多因素logistic回归分析。结果 D5组与D6组比较，妊娠和新生儿结局各项指标无统计学差异（P > 0.05）。TE-A组人绒毛膜促性腺激素（HCG）阳性率、临床妊娠率和单胎活产率高于TE-B组（P < 0.05），其余指标无统计学差异（P > 0.05）。ICM-A组HCG阳性率、临床妊娠率、活产率、单胎活产率明显高于ICM-B组（P < 0.05），其余指标无统计学差异。多因素logistic回归分析结果表明，年龄、受精方式、ICM是引起临床妊娠率差异的独立影响因素，年龄、ICM是引起活产率差异的独立影响因素。结论 冻融优质单囊胚移植时，囊胚发育速度不能预测妊娠结局，ICM评级较TE评级对临床妊娠率和活产率有更高的预测价值，而不同发育速度和质量评级对新生儿结局无明显影响。

冻融周期优质单囊胚的选择策略

陈丽娜, 王秀霞

中国医科大学附属盛京医院生殖医学中心, 沈阳 110022

收稿日期:2020-12-31出版日期:2021-10-30发布日期:2021-10-11
通讯作者:王秀霞E-mail:18940251898@163.com
作者简介:陈丽娜(1994-),女,硕士研究生.
基金资助:国家自然科学基金（81671423）


关键词: 单囊胚移植, 优质囊胚, 妊娠结局, 新生儿结局
Abstract: Objective To investigate the effects of blastocyst development speed, inner cell mass (ICM) rating, and trophectoderm (TE) rating of frozen-thawed high-quality single-blastocyst transfer on pregnancy and neonatal outcomes. Methods We divided 938 high-quality single-blastocyst transfer cycles into two groups according to blastocyst formation time[D5 (on the 5th day after fertilization, n=653) and D6 (on the 6th day after fertilization, n=285)], TE quality[TE-A (n=371) and TE-B (n=567)], and ICM quality[ICM-A (n=607) and ICM-B (n=331)]. Pregnancy and neonatal outcomes were compared and the factors affecting clinical pregnancy and live birth rates were analyzed through multivariate logistic regression analysis. Results There was no significant difference in the pregnancy and neonatal outcomes between D5 and D6 groups (P > 0.05). The human chorionic gonadotropin (HCG)-positive, clinical pregnancy, and single live birth rates were significantly higher in the TE-A group than in the TE-B group (P < 0.05). The HCG-positive, clinical pregnancy, live birth, and single live birth rates were significantly higher in the ICM-A group than in the ICM-B group (P < 0.05). Multivariate logistic regression analysis showed that fertilization method was independently associated with clinical pregnancy rates, and age and ICM were independently associated with both clinical pregnancy and live birth rates. Conclusion In frozen-thawed high-quality single-blastocyst transfer, blastocyst development speed was not predictive of pregnancy outcomes, while ICM rating had a higher predictive value than TE rating for clinical pregnancy and live birth rates. Different development speeds and quality ratings had no significant effect on neonatal outcomes.
Key words: single-blastocyst transfer, high-quality blastocyst, pregnancy outcome, neonatal outcome
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