摘要： 目的·探讨单囊胚冻融移植周期中胚龄对CC级别囊胚妊娠结局的影响。方法·纳入2017年4月—2019年12月于上海永远幸妇科医院进行单个冻融囊胚移植的565例患者，分为高质量囊胚组（AA、AB、BA级，
n=189）、中质量囊胚组（BB、AC、CA级，
n=114）、低质量囊胚组（CB、BC级，
n=140）和CC级别囊胚组（
n=122）。其中，CC级别囊胚组按照胚龄进一步分为D5亚组（
n=26）、D6亚组（
n=81）和D7亚组（
n=15）。对4个不同级别囊胚组及3个CC级别囊胚胚龄亚组的周期特征及妊娠结局进行比较。结果·高质量囊胚组、中质量囊胚组、低质量囊胚组、CC级别囊胚组的临床妊娠率（58.7%
vs 54.4%
vs 47.1%
vs 25.4%，
P=0.000）和活产率（46.2%
vs 43.2%
vs 36.2%
vs 17.6%，
P=0.000）依次降低。多元回归分析显示，胚胎质量与临床妊娠率显著相关。与高质量囊胚相比，CC胚胎的临床妊娠率较低（a
OR=0.81，95%
CI 0.71~0.93，
P=0.003）。CC级别囊胚胚龄亚组分析显示，D5、D6和D7亚组的临床妊娠率（42.3%
vs 23.5%
vs 6.7%，
P=0.040）和活产率（31.6%
vs 15.6%
vs 0，
P=0.133）依次降低。多元回归分析显示，胚龄对CC级别囊胚移植临床妊娠率有显著影响。相较于D5的CC级别胚胎，D7的CC级别胚胎的临床妊娠率更低（a
OR=0.69，95%
CI 0.49~0.96，
P=0.032）。结论·D5的CC级别囊胚具有很好的妊娠结局，临床价值高。D6的CC级别囊胚虽然妊娠率较低，但仍具有一定的临床价值，而D7的CC级别囊胚临床价值较小。
关键词: 囊胚质量, CC级别囊胚, 临床妊娠率, 单囊胚冻融移植 Abstract: Objective· To assess the effect of embryonic age on the pregnancy outcomes of blastocyst graded as CC in single frozen-thawed blastocyst transfer cycles.
Methods· A total of 565 patients undergoing single frozen-thawed blastocyst transfer at Shanghai TOWAKO Hospital from April 2017 to December 2019 were included in this study, and they were divided into high-quality blastocyst group (grade AA, AB, and BA; n=189), medium-quality blastocyst group (grade BB, AC, and CA; n=114), low-quality blastocyst group (grade CB and BC; n=140) and CC grade blastocyst group (n=122). And the CC grade blastocysts were further divided into CC grade blastocysts of Day 5 (D5 subgroup, n=26), Day 6 (D6 subgroup, n=81) and Day 7 (D7 subgroup, n=15) according to the embryonic age. Thereafter, the cycle characteristics and pregnancy outcomes of the four groups and the three embryonic age subgroups of CC grade blastocysts were compared.
Results· The clinical pregnancy rate (58.7% vs 54.4% vs 47.1% vs 25.4%, P=0.000) and live birth rate (46.2% vs 43.2% vs 36.2% vs 17.6%, P=0.000) of the high-quality, medium-quality, low-quality, and CC grade blastocyst groups decreased sequentially. Multivariate analysis showed that embryo quality was significantly correlated with clinical pregnancy rate. Compared with high-quality blastocyst group, CC grade blastocyst group had a lower clinical pregnancy rate (aOR=0.81, 95%CI 0.71?0.93, P=0.003). The analysis of CC grade blastocyst embryonic age subgroups showed that the clinical pregnancy rate (42.3% vs 23.5% vs 6.7%, P=0.040) and live birth rate (31.6% vs 15.6% vs 0, P=0.133) of the D5, D6 and D7 subgroups also decreased sequentially. Multivariate analysis showed that the embryonic age had a significant impact on the clinical pregnancy rate of CC grade blastocyst transfer. Compared with the D5 subgroup, the D7 subgroup had a lower clinical pregnancy rate (aOR=0.69, 95%CI 0.49?0.96, P=0.032).
Conclusion· D5 CC grade blastocysts predict good pregnancy outcome. Although the clinical pregnancy rate of D6 CC grade blastocysts is low, they are still useable. However, D7 CC grade blastocysts are of little clinical value.
Key words: blastocyst quality, blastocyst graded as CC, clinical pregnancy rate, single frozen-thawed blastocyst transfer PDF全文下载地址:
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