单枚玻璃化冷冻复苏的BB/BC/CB囊胚移植活产率的重要参考：卵裂期胚胎质量与胚胎发育速度
The Valuable Reference of Live Birth Rate in the Single Vitrified-Warmed BB/BC/CB Blastocyst Transfer: The Cleavage-Stage Embryo Quality and Embryo Development Speed.
作者信息
Shen Xi, Long Hui, Gao Hongyuan, Guo Wenya, Xie Yating, Chen Di, Cong Yanyan, Wang Yun, Li Dongying, Si Jiqiang, Zhao Leiwen, Lyu Qifeng, Kuang Yanping, Wang Li
机构信息
Department of Assisted Reproduction, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China.
出版信息
Front Physiol. 2020 Sep 10;11:1102. doi: 10.3389/fphys.2020.01102. eCollection 2020.
BACKGROUND
It is unclear whether we should focus attention on cleavage-stage embryo quality and embryo development speed when transferring single particular grade vitrified-warmed blastocysts, especially poor-quality blastocysts (grade "C").
METHOD
This retrospective study considered 3386 single vitrified-warmed blastocyst transfer cycles from January 2010 to December 2017. They were divided into group 1 (AA/AB/BA, = 374), group 2 (BB, = 1789), group 3 (BC, = 901), and group 4 (CB, = 322). The effects of cleavage-stage embryo quality and embryo development speed were measured in terms of clinical pregnancy and live birth rates in each group.
RESULTS
Pregnancy outcomes showed a worsening trend from groups 1 to 4; the proportion of embryos with better cleavage-stage quality and faster development speed decreased. In group 1, only the blastocyst expansion degree 3 was a negative factor in the clinical pregnancy rate (odds ratio (OR) [95% confidence interval (CI)]: 0.233 [0.091-0.595]) and live birth rate (0.280 [0.093-0.884]). In the other groups (BB, BC, and CB), blastocysts frozen on day 5 had significantly better clinical pregnancy outcomes than those frozen on day 6: 1.373 [1.095-1.722] for group 2, 1.523 [1.055-2.197] for group 3, and 3.627 [1.715-7.671] for group 4. The live birth rate was 1.342 [1.060-1.700] for group 2, 1.544 [1.058-2.253] in group 3, and 3.202 [1.509-6.795] in group 4, all s < 0.05). The degree of blastocoel expansion three for clinical pregnancy rate in group 2 (0.350 [0.135-0.906], < 0.05) and day 3 blastomere number (>7) for live birth rate in group 4 (2.455 [1.190-5.063], < 0.05) were two important factors.
CONCLUSION
We should consider choosing BB/BC/CB grade blastocysts frozen on day 5, CB grade blastocysts with day 3 blastomere numbers (>7), and AA/AB/BA grade blastocysts with degrees of expansion (≥4) to obtain better pregnancy outcomes.
背景
在移植单个特定等级的玻璃化冷冻复苏囊胚，尤其是低质量囊胚（“C”级）时，是否应关注卵裂期胚胎质量和胚胎发育速度尚不清楚。
方法
这项回顾性研究纳入了2010年1月至2017年12月期间3386个单胚胎玻璃化冷冻复苏囊胚移植周期。它们被分为第1组（AA/AB/BA，n = 374）、第2组（BB，n = 1789）、第3组（BC，n = 901）和第4组（CB，n = 322）。根据每组的临床妊娠率和活产率来衡量卵裂期胚胎质量和胚胎发育速度的影响。
结果
妊娠结局从第1组到第4组呈恶化趋势；卵裂期质量较好且发育速度较快的胚胎比例下降。在第1组中，仅囊胚扩张程度3是临床妊娠率（优势比（OR）[95%置信区间（CI）]：0.233[0.091 - 0.595]）和活产率（0.280[0.093 - 0.884]）的负性因素。在其他组（BB、BC和CB）中，第5天冷冻的囊胚临床妊娠结局明显优于第6天冷冻的囊胚：第2组为1.373[1.095 - 1.722]，第3组为1.523[1.055 - 2.197]，第4组为3.627[1.715 - 7.671]。第2组的活产率为1.342[1.060 - 1.700]，第3组为1.544[1.058 - 2.253]，第4组为3.202[1.509 - 6.795]，均P < 0.05）。第2组中囊胚腔扩张程度3对临床妊娠率（0.350[0.135 - 0.906]，P < 0.05）以及第4组中第3天卵裂球数量（>7）对活产率（2.455[1.190 - 5.063]，P < 0.05）是两个重要因素。
结论
为获得更好的妊娠结局，应考虑选择第5天冷冻的BB/BC/CB级囊胚、第3天卵裂球数量（>7）的CB级囊胚以及扩张程度（≥4）的AA/AB/BA级囊胚。
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