天津医药 ›› 2015, Vol. 43 ›› Issue (3): 300-303.doi: 10.11958/j.issn.0253-9896.2015.03.021

• 应用研究 • 上一篇    下一篇

如何优化胚胎冻存方案改善患者妊娠结局

张玥 1,2, 张云山 1△, 薛凤霞 2   

  1. 1 天津医科大学中心妇产科临床学院生殖医学中心(邮编 300100)2 天津医科大学总医院
  • 收稿日期:2014-03-21 修回日期:2014-07-25 出版日期:2015-03-15 发布日期:2015-03-15
  • 通讯作者: 张云山 E-mail:yuezhang77@aliyun.com
  • 作者简介:张玥 (1977), 女, 硕士, 副主任医师, 主要从事女性不孕症方面研究

How to improve the pregnancy outcome by optimizing embryo cryopreservation protocol

ZHANG Yue1,2, ZHANG Yunshan1△, XUE Fengxia2#br#   

  1. 1 Tianjin Central Obstetrics and Gynecology Hospital, Tianjin 300100,China; 2 Tianjin Medical University General Hospital
  • Received:2014-03-21 Revised:2014-07-25 Published:2015-03-15 Online:2015-03-15
  • Contact: ZHANG Yunshan E-mail:yuezhang77@aliyun.com

摘要: 目的 探讨如何优化胚胎冻存的方案以提高胚胎解冻移植的成功率, 降低多胎率, 增加一次取卵的累积妊娠率。方法 回顾性分析 1 166 个冻融胚胎移植(FET)周期的临床资料, 分为玻璃化冷冻组(445)和慢速程序冷冻组(721); 445 个玻璃化冷冻 FET 周期分为单胚组(28 个周期)、 双胚组(71 个周期)、 三胚组(346 个周期)。 0~1 个优胚为 O0~1 组(235 个周期)、 2 个优胚为 O2 组(80 个周期), 3 个优胚为 O3组 (130 个周期)。比较各组之间的妊娠结局 (着床率、 临床妊娠率、 流产率及活产率)。结果 (1) 玻璃化冷冻组的胚胎复苏成活率 (98.3% vs 73.1%)、无损伤胚胎复苏率 (83.3% vs 62.1%)、 着床率 (36.8% vs 29.9%)、 临床妊娠率 (57.1% vs 44.0%) 及活产率 (47.9% vs 34.5%)高于慢速程序冷冻组(P<0.05)。(2)三胚组的临床妊娠率(62.7% vs 39.4% vs 32.1%)、 多胎率(37.6% vs 10.7% vs 0)及活产率(52.6% vs 31.0% vs 21.4%)明显高于单胚和双胚组(P<0.05)。(3) O2~3组的着床率(33.0% vs 27.1%)、 临床妊娠率 (65.2% vs 48.1%)、 多胎率 (38.0% vs 20.4%) 及活产率 (56.2% vs 39.2%)高于 O0~1组 (P<0.05)。(4) O3组的着床率 (36.8% vs 26.3%)和多胎率(46.7% vs 21.3%)高于 O2 组(P<0.05); 但两组间临床妊娠率(69.2% vs 58.8%)、 流产率(15.6% vs 10.6%)、 异位妊娠率(0 vs 0)、 活产率 (58.5% vs 52.5%)及早产率 (26.3% vs 14.3%)差异均无统计学意义 (P>0.05)。结论 采用玻璃化冷冻技术可以提高临床妊娠率和活产率、 降低多胎率, 且每管冻存 2 个优胚效果最好。

关键词: 冷冻胚胎移植, 玻璃化冷冻, 慢速程序化冷冻, 优胚, 累积妊娠率

Abstract: Objective To investigate how to optimize the protocol of embryo cryopreservation to improve the success of frozen-thawed embryo transfer (FET), reduce multiple pregnancy rate and increase the cumulative pregnancy rate from one oocyte retrieval process. Methods The clinical data of 1 166 FET cycles were retrospectively analyzed and separated into different groups: 445 for vitrification and 721 for slow-freezing. The vitrification group was divided into single embryo (28 cy⁃ cles), double embryos (71 cycles) and triple embryos (346 cycles). 0-1 optimal embryo was called O0-1 group (235 cycles), 2 optimal embryos were called O2 group (80 cycles), 3 optimal embryos were called O3 group (130 cycles). The difference preg⁃ nancy outcomes (implantation rate, clinical pregnancy, abortion rate and live- birth rate) were compared between groups. Results (1) There were significantly higher embryo survival rate(98.3% vs 73.1%), embryo recovery rate without damaging (83.3% vs 62.1%), implantation rate(36.8% vs 29.9%), clinical pregnancy(57.1% vs 44.0%) and live-birth rate(47.9% vs 34.5%) in vitrification group than those of slow freezing group(P<0.05). (2) There were significantly higher clinical pregnan⁃ cy rate(62.7% vs 39.4% vs 32.1%), multiple pregnancy rate(37.6% vs 10.7% vs 0%) and live-birth rate(52.6% vs 31.0% vs 21.4%)in triple embryos group than those of the single and double embryos groups (P<0.05). (3) There were significantly higher implantation rate(33.0% vs 27.1%), clinical pregnancy(65.2% vs 48.1%), multiple pregnancy rate(38.0% vs 20.4%) and live-birth rate(56.2% vs 39.2%) in O2-3 group than those of O0-1 group(P<0.05). (4) There were significantly higher im⁃ plantation rate(36.8% vs 26.3%) and multiple pregnancy rate (46.7% vs 21.3%) in O3 group than those of O2 group (P<0.05). There were no significant differences in clinical pregnancy(69.2% vs 58.8%), abortion rate(15.6% vs 10.6%), ectopic pregnancy rate(0 vs 0), live-birth rate(58.5% vs 52.5%) and preterm birth rate(26.3% vs 14.3%) between two groups (P>0.05). Conclusion Vitrification technology can improve the clinical pregnancy and live-birth rate, and decrease multiple preg⁃ nancy rate. Two optimal embryos in one tube are supposed to be the preferred method for embryo cryopreservation.

Key words: frozen-thawed embryo transfer(FET), vitrification, slow-freezing, optimal embryo, cumulative pregnancy rate