论文部分内容阅读
目的探讨第3天胚胎卵裂球数目与妊娠结局的关系。方法分析2013年该院生殖中心收治的969例新鲜周期移植患者的胚胎情况,通过A、B、C、D 4种方案比较移植第3天不同卵裂球数目的胚胎后的妊娠结局。A方案将969例患者的胚胎根据是否优质胚胎分成均为优质胚胎组、至少1个优质胚胎组及无优质胚胎组;B方案将优质胚胎分成7细胞组、8细胞组及9细胞组;C方案比较了移植2个胚胎的病例中,≤6细胞组、7细胞组、8细胞组、9细胞组及≥10细胞组的妊娠结局;D方案比较了移植单胚胎的病例中,≤6细胞组、7细胞组、8细胞组、9细胞组及≥10细胞组的妊娠结局。结果 A方案中,均为优质胚胎组妊娠率及胚胎着床率最高(44.89%,30.83%),至少1个优质胚胎组其次(42.02%,24.08%),无优质胚胎组最低(31.30%,21.55%),各组临床妊娠率比较,差异均无统计学意义(P>0.05),而均为优质胚胎组的胚胎着床率与其余两组比较,差异均有统计学意义(P<0.05)。B方案中,8细胞组妊娠率及胚胎着床率(47.77%,33.28%)与7细胞组相当(46.30%,34.12%),两组均显著高于9细胞组(20.00%,14.29%),但差异均无统计学意义(P>0.05)。C方案中,8细胞组的胚胎着床率(24.36%)略高于≥10细胞组(22.22%),两组均明显高于9细胞组(15.63%)、7细胞组(13.76%)及≤6细胞组(10.00%),仅8细胞组与6细胞组及8细胞组与7细胞组胚胎着床率比较,差异有统计学意义(P<0.05)。D方案中,7细胞组的胚胎着床率(33.33%)略高于8细胞组(29.79%)和≥10细胞组(28.57%),3组均明显高于≤6细胞组(11.76%)及9细胞组(0.00%),仅6细胞组与7细胞组胚胎着床率比较,差异有统计学意义(P<0.05)。结论妊娠结局与第3天胚胎卵裂球数目密切相关。在选择胚胎移植时,优质胚胎应为首选,7、8细胞的胚胎应作为优先选择的对象,在无优质胚胎可以选择的情况下,非优质胚胎也可以作为后备选择,其中≥10细胞胚胎明显优于≤6细胞胚胎。由于移植≤6细胞胚胎的着床率较低,建议将此类胚胎继续培养,培养后如果能够形成良好的囊胚再予以移植,以提高胚胎着床率并减轻患者经济上的负担。
Objective To investigate the relationship between embryonic blastomeres and pregnancy outcomes on the third day. METHODS: The embryos of 969 patients with fresh-cycle grafts admitted to the Reproductive Center of the hospital in 2013 were analyzed. The pregnancy outcomes were compared between the three embryos on the 3rd day after transplanting with the 4 protocols of A, B, C and D. A plan 969 cases of embryos were divided according to whether the high quality embryos were high quality embryos, at least one high quality embryos and no quality embryos; B program will be divided into high quality embryos into 7 cells, 8 cells and 9 cells group; C In the case of 2 embryos transplanted, the pregnancy outcome of ≤6 cell group, 7 cell group, 8 cell group, 9 cell group and ≥10 cell group was compared. In the case of transplantation single embryo, D ≤6 cells Group, 7 cell group, 8 cell group, 9 cell group and> 10 cell group. Results The results showed that pregnancy rate and embryo implantation rate were the highest in high quality embryo group (44.89%, 30.83%), followed by at least one high quality embryo group (42.02%, 24.08%), the lowest quality embryo group (31.30% 21.55%, respectively). There was no significant difference in the clinical pregnancy rates between the two groups (P> 0.05), while the embryo implantation rates of the high quality embryos group were significantly different from the other two groups (P <0.05 ). In the B regimen, pregnancy rates and embryo implantation rates in the 8-cell group (47.77%, 33.28%) were comparable to those in the 7-cell group (46.30%, 34.12% , But the differences were not statistically significant (P> 0.05). In the C regimen, embryo implantation rate in 8-cell group was slightly higher than that in ≥10 cell group (22.22%), significantly higher in 9-cell group (15.63%), 7-cell group (13.76% ≤6 cells (10.00%), only 8 cells and 6 cells and 8 cells and 7 cells embryos implantation rate, the difference was statistically significant (P <0.05). D, the embryo implantation rate in 7-cell group was slightly higher than that in 8-cell group (29.79%) and ≥10-cell group (28.57% And 9 cell group (0.00%). There was significant difference in embryo implantation rate between 6 cell group and 7 cell group (P <0.05). Conclusions The pregnancy outcome is closely related to the number of blastomeres on the 3rd day. In the choice of embryo transfer, high quality embryos should be the first choice, 7,8 cell embryos should be the preferred object, in the absence of high quality embryos can choose the case, non-high quality embryos can also be used as a backup option, in which ≥ 10 embryos were significantly Better than ≤ 6 cell embryos. Due to the low implantation rate of ≤6 cell embryos, it is recommended to continue culturing these embryos. If the embryos can be transplanted after being cultured, the embryo implantation rate can be increased and the economic burden of the patients can be reduced.