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目的:研究体外受精中慢卵裂非优质胚胎冻融后的发育潜能及临床应用价值。方法:对行冷冻胚胎解冻的875个周期进行回顾性分析,根据卵裂球分裂程度将胚胎分为A组(卵裂球分裂速度正常,即冷冻前有≥1枚胚胎卵裂球数≥6个)和B组(卵裂球分裂速度慢,卵裂球数4~5个),A组胚胎均在移植当天解冻,培养1~3 h后移植。B组胚胎在移植前1 d解冻,培养18~24 h后依据生长情况再分成3个亚组:胚胎全部生长组(B1组),即培养18~24 h后胚胎全部生长,卵裂球数在6~9个之间;部分胚胎生长组(B2组),即≥1枚胚胎生长且卵裂球数≥6-细胞;胚胎未生长组(B3组),即复苏后所有胚胎均没有继续生长分裂。比较各亚组间胚胎复苏率、卵裂球全部完整复苏率、临床妊娠率、种植率和流产率的差异。结果:875个冷冻胚胎中A组617个周期,成功解冻612个周期,解冻复苏后移植,临床妊娠295例(48.46%),种植率为29.32%。B组258个周期,成功解冻255个周期,其中B1组167个周期,B2组52个周期,B3组36个周期,B1、B2均进行了移植,临床妊娠率分别为28.74%(48/167)和25.00%(13/52),B1、B2组间差异无统计学意义(P>0.05),B3组中12例因患者要求进行了移植,11例种植失败,1例仅生化妊娠,临床妊娠率为0%;B组种植率为23.29%。B组冻融后临床妊娠率(27.85%)和种植率均低于A组(P<0.05),但两者在胚胎复苏率、卵裂球全部完整复苏率、流产率等方面无统计学差异(P>0.05)。结论:第3日形态正常但发育缓慢的胚胎(细胞数<6个)仍具有临床应用价值,冻融后培养18~24 h有利于鉴别胚胎的发育潜能,对于冻融后培养18~24 h未继续卵裂者不建议进行移植。
Objective: To investigate the developmental potential and clinical value of non-high quality embryos in IVF after freezing and thawing. Methods: The 875 cycles of thawed frozen embryo were retrospectively analyzed. According to the degree of cleavage of the blastomere, the embryos were divided into group A (blastomere schizophrenia rate was normal, that is, ≥1 blastomere number≥6 ) And group B (blastomere splitting rate was slow, blastomere number 4 to 5), group A embryos were thawed on the day of transplantation, cultured 1 ~ 3 h after transplantation. The embryos in group B were thawed at 1 day before transplantation and were further divided into three subgroups according to their growth after 18-24 hours of culture: all embryos were grown (group B1), that is, all embryos were grown after culturing for 18-24 h (Group B2), that is, more than one embryo grew and the number of blastomeres was more than 6-cell. In embryo non-growth group (group B3), all the embryos did not continue after resuscitation Growing split. The differences of embryo resuscitation rate, complete recovery of blastomere, clinical pregnancy rate, implantation rate and abortion rate were compared among the subgroups. Results: A group of 875 frozen embryos 617 cycles, thawed 612 cycles, thawed and thawed after transplantation, clinical pregnancy 295 cases (48.46%), the planting rate was 29.32%. In Group B, 258 cycles were successfully thawed, 255 cycles were successfully thawed, of which 167 cycles were in Group B1, 52 cycles in Group B2, 36 cycles in Group B3, and B1 and B2 were all transplanted. The clinical pregnancy rates were 28.74% (48/167 ) And 25.00% (13/52) respectively. There was no significant difference between B1 and B2 groups (P> 0.05). In group B3, 12 patients were required for transplantation, 11 patients failed to implant, 1 patient had biochemical pregnancy only, Pregnancy rate was 0%; Group B planting rate was 23.29%. The clinical pregnancy rate (27.85%) and implantation rate in group B were lower than those in group A (P <0.05), but there was no significant difference between the two groups in embryo recovery rate, complete recovery rate of blastomere and abortion rate (P> 0.05). CONCLUSION: The morphologically normal but slowly growing embryos (number of cells <6) still have clinical value on the third day. After freezing and thawing for 18-24 h, it is helpful to identify the embryo developmental potential. After freezing and thawing, the embryos cultured for 18-24 h No further rupture is not recommended for transplantation.