冻融胚胎复苏后培养时间对临床妊娠率的影响

【摘要】 目的 探讨卵裂期冻融胚胎复苏后体外培养时间对冻融胚胎移植（FET）周期临床妊娠率的影响。 方法 收集2016年1月至12月在海军军医大学（第二军医大学）长海医院生殖医学中心接受FET助孕的692例患者的临床资料。根据胚胎复苏后移植前体外培养的天数将患者分为3组：D0组（复苏后当天未培养）、D1组（复苏后培养1d）、D2组（复苏后培养2 d），分析比较三组间的妊娠结局。结果 三组患者年龄、体质量指数、不孕年限、基础FSH水平以及内膜准备方案组成均没有统计学差异（P>0.05）;随着冷冻胚胎复苏后培养时间的增加，胚胎丢失率逐渐增加（D0组0.0%→D1组13.3%→D2组43.0%，P<0.05）。三组移植日子宫内膜厚度及平均移植胚胎数均无差异（P>0.05）；尽管D2组及D1组优质胚胎移植率均低于D0组（P<0.05），但D2组临床妊娠率却高于D0组（62.7% VS 38.6%，P<0.05）、D1组与D0组无统计学差异（45.2% VS 38.6%，P>0.05）。 结论 解冻卵裂期胚胎进行体外培养1～2天后移植，虽然增加胚胎丢失率，但可筛选具有发育潜能的胚胎，显著提高临床妊娠率，因此临床医生需要权衡利弊及风险。

Effect of culture time of frozen embryo after thawing on clinical pregnancy rate

Objective To explore the effects of in vitro culture time of frozen cleavage embryo after thawing on clinical pregnancy rate during frozen-thawed embryo transfer (FET) cycles. Methods The clinical data of 692 patients were analyzed; they received FET in the Department of Reproductive Medicine Center, Changhai Hospital, Navy Medical University (Second Military Medical University) from January to December in 2016. According to the days of in vitro culture between thawing and transferring, the patients were divided into three groups:no in vitro culture group, 1-day in vitro culture group and 2-day in vitro culture group. The pregnancy outcomes were compared between the three groups. Results There were no significant differences in age, body mass index, infertile duration, basic follicle-stimulating hormone (FSH) level or endometrial preparation protocol between the three groups (all P>0.05). The embryo loss rates of the no in vitro culture group, the 1-day in vitro culture group and the 2-day in vitro culture group were 0.0% (0/706), 13.3% (64/481) and 43.0% (114/265), respectively, and the difference was statistically significant (P<0.01). There were no significant differences in number of transfered embryo or endometrial thickness on transplantation day between the three groups (both P>0.05). The good-quality embryo transfer rates in the 2-day in vitro culture group and 1-day in vitro culture group were significantly lower than that in the no in vitro culture group (both P<0.01), and the clinical pregnancy rate in the 2-day in vitro culture group was significantly higher than that in the no in vitro culture group (P<0.01). Conclusion In vitro culture for 1-2 days after thawing frozen cleavage embryos may increase the embryo loss rate, but it can improve the clinical pregnancy rate by screening the embryos with developmental potential.