新鲜或冷冻第6天囊胚移植：还有问题吗？

Fresh or frozen day 6 blastocyst transfer: is there still a question?

作者信息

Ferreux Lucile, Bourdon Mathilde, Chargui Ahmed, Firmin Julie, Maignien Chloé, Santulli Pietro, Patrat Catherine, Pocate-Cheriet Khaled

机构信息

Hôpitaux de Paris (AP- HP), APHP, Centre - Université de Paris Cité, Hôpital Cochin, Service de Biologie de la Reproduction-CECOS, Paris, France.

Université de Paris Cité, Institut Cochin, U1016, INSERM, CNRS, Paris, F-75014, France.

出版信息

Reprod Biol Endocrinol. 2024 Apr 24;22(1):50. doi: 10.1186/s12958-024-01214-w.

DOI:10.1186/s12958-024-01214-w

PMID:38659014

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11040818/

Abstract

BACKGROUND

The Live Birth Rate (LBR) after day 5 (D5) blastocyst transfer is significantly higher than that with D6 embryos in both fresh and frozen-vitrified embryo transfer cycles, according to the most recently published meta-analyses. Therefore, for women obtaining only D6 blastocysts, the chances of pregnancy may be lower but nonetheless sufficient to warrant transferring such embryos. The best strategy for transfer (i.e., in fresh versus frozen cycles) remains unclear and there is a paucity of data on this subject.

METHODS

A total of 896 couples with D6 single blastocyst transfers were retrospectively analyzed: patients receiving a fresh D6 embryo transfer (Fresh D6 transfer group, n = 109) versus those receiving a frozen-thawed D6 embryo transfer (Frozen D6 transfer group, n = 787). A subgroup comprising a freeze-all cycle without any previous fresh or frozen D5 embryo transfers (Elective frozen D6, n = 77) was considered and also compared with the Fresh D6 transfer group. We compared LBR between these two groups. Correlation between D6 blastocyst morphology according to Gardner's classification and live birth occurrence was also evaluated. Statistical analysis was carried out using univariate and multivariate logistic regression models.

RESULTS

The LBR was significantly lower after a fresh D6 blastocyst transfer compared to the LBR with a frozen-thawed D6 blastocyst transfer [5.5% (6/109) vs. 12.5% (98/787), p = 0.034]. Comparison between LBR after Elective frozen D6 group to the Fresh D6 blastocyst transfers confirmed the superiority of frozen D6 blastocyst transfers. Statistical analysis of the blastocyst morphology parameters showed that both trophectoderm (TE) and inner cell mass (ICM) grades were significantly associated with the LBR after D6 embryo transfer (p < 0.001, p = 0.037). Multiple logistic regression revealed that frozen D6 thawed transfer was independently associated with a higher LBR compared with fresh D6 transfer (OR = 2.54; 95% CI: [1.05-6.17]; p = 0.038). Our results also show that transferring a good or top-quality D6 blastocyst increased the chances of a live birth by more than threefold.

CONCLUSIONS

Our results indicate that transferring D6 blastocysts in frozen cycles improves the LBR, making it the best embryo transfer strategy for these slow-growing embryos.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

背景

根据最近发表的荟萃分析，在新鲜和冷冻-玻璃化胚胎移植周期中，第5天（D5）囊胚移植后的活产率（LBR）显著高于第6天胚胎移植后的活产率。因此，对于仅获得第6天囊胚的女性，怀孕几率可能较低，但仍足以保证移植此类胚胎。最佳的移植策略（即新鲜周期与冷冻周期）仍不明确，且关于这一主题的数据较少。

方法

对总共896例行第6天单囊胚移植的夫妇进行回顾性分析：接受新鲜第6天胚胎移植的患者（新鲜第6天移植组，n = 109）与接受冻融第6天胚胎移植的患者（冷冻第6天移植组，n = 787）。考虑了一个亚组，该亚组为未进行过任何新鲜或冷冻第5天胚胎移植的全冻周期（选择性冷冻第6天，n = 77），并与新鲜第6天移植组进行比较。我们比较了这两组之间的活产率。还评估了根据加德纳分类法的第6天囊胚形态与活产发生之间的相关性。使用单变量和多变量逻辑回归模型进行统计分析。

结果

新鲜第6天囊胚移植后的活产率显著低于冻融第6天囊胚移植后的活产率[5.5%（6/109）对12.5%（98/787），p = 0.034]。选择性冷冻第6天组与新鲜第6天囊胚移植后的活产率比较证实了冷冻第6天囊胚移植的优越性。囊胚形态参数的统计分析表明，滋养外胚层（TE）和内细胞团（ICM）等级均与第6天胚胎移植后的活产率显著相关（p < 0.001，p = 0.037）。多变量逻辑回归显示，与新鲜第6天移植相比，冷冻第6天解冻移植与更高的活产率独立相关（OR = 2.54；95% CI：[1.05 - 6.17]；p = 0.038）。我们的结果还表明，移植优质或顶级质量的第6天囊胚可使活产几率增加三倍以上。