目的 探讨体外受精治疗中第3天(D3)不同质量卵裂期胚胎培养至囊胚的发育潜能,为囊胚培养提供实验室依据。方法 对2015年4月—2019年4月D3移植或冷冻后剩余行囊胚培养的5 510枚胚胎进行了回顾性分析。按D3胚胎质量、卵裂球数目、均一性及碎片率分组,比较囊胚形成率,优质囊胚形成率及可利用囊胚形成率,并分析各因素与可利用囊胚形成的相关性。结果 D3优质胚胎的囊胚形成率,优质囊胚形成率及可利用囊胚形成率与非优质胚胎组相比有统计学差异(P＜0.05);4-6细胞组及＜4细胞组与7-9细胞组相比有统计学差异(P＜0.05),但融合期胚胎(CP)组及＞ 9细胞组与7-9细胞组相比差异无统计学意义;卵裂球大小差异(+)组和(++/+++)组与卵裂球大小均匀(-)相比有统计学差异(P＜0.05); 10%～25%组及碎片＞25%组与碎片≤10%组相比有统计学差异(P＜0.05)。 Logistic分析结果表明,D3胚胎质量、卵裂球数目、均一性及胚胎碎片率与可利用囊胚形成显著相关(P＜0.05)。 结论 D3胚胎质量、卵裂球数目、均一性及胚胎碎片均会影响到囊胚的形成及质量,其中胚胎质量和卵裂球数目对可利用囊胚形成的影响较大。

Objective To explore the developmental potential of day 3(D3) different quality embryos cultured to blastocyst in vitro fertilization treatment, and to provide laboratory basis for blastocyst culture. Methods A total of 5 510 embryos with blastocyst culture remained after D3 transplantation or freezing from April 2015 to April 2019 were analyzed retrospectively. They were divided into groups according to embryo quality, blastomere number, blastomere homogeneity and fragment rate in D3. And the blastocyst formation rate, high quality blastocyst formation rate and available blastocyst formation rate were compared between the groups.The correlation within each factor and available blastocyst formation was analyzed. Results The blastocyst formation rate, high quality blastocyst formation rate and available blastocyst formation rate of D3 high quality embryo group were higher than those of non-high quality embryo group (P<0.05); compared with 7- 9 cell group, 4- 6 cell group and<4 cell group were lower (P<0.05), but there was no significant difference in CP group or >9 cell group. Compared with the normal size of the blastomere (-), the difference in the size of the blastomere (+) group and the (++/+++) group decreased (P<0.05); compared with the fragment ≤ 10%, the difference in the size of the blastomere between the 10%~25% group and the fragment>25% group decreased (P<0.05). The results of logistic analysis suggested that the embryo quality, blastomere number, homogeneity and fragment rate of D3 were correlated with available blastocyst formation (P<0.05). Conclusion D3 embryo quality, blastomere number, homogeneity and embryo fragment may affect the formation and quality of blastocyst, especially the embryo quality and blastomere number.

目的 探讨35周岁以下患者行D5单囊胚移植的可行性。方法 回顾性分析2016年1月—2019年7月期间,女方年龄≤35岁,在本中心行新鲜周期全胚冻后第一冻融移植的663个周期,根据胚胎发育天数及囊胚移植数目分为三组:D3双优胚移植组(D3双优组:n=508)、D5单囊胚移植组(D5单囊组:n=47)、D5双囊胚移植组(D5双囊组:n=108),对三组的临床结局进行比较分析。结果 D5双囊组临床妊娠率高于D3双优组及D5单囊组,且差异有统计学意义(P＜0.05),但D5单囊组与D3双优组相比,无统计学差异(P＞0.05);D5单囊胚的多胎率低于D5双囊组及D3双优组,差异均有统计学意义(P＜0.001),D3双优组的多胎率也低于D5双囊组,差异亦有统计学意义(P＜0.05);D5单囊组和D5双囊组的种植率都高于D3双优组,差异都有统计学意义(分别是P＜0.05,P＜0.001),而D5单囊组合D5双囊组之间无统计学差异(P＞0.05);但三组之间的早期流产率及宫外孕率均无统计学差异(P＞0.05)。结论 年龄≤35周岁的患者全胚冷冻后第一冻融移植周期选择D5单囊胚进行移植,既能获得良好的临床妊娠率和种植率,又极大降低多胎妊娠率。

Objective To investigate the clinical outcomes of the single blastocyst transfer of day 5 in the women under 35 years old. Methods A retrospective study was conducted to analyze clinical outcomes of women less than 35 years old and experienced embryo transfer in the first frozen-thawed cycles from January 2016 to July 2019 in the Center of Reproductive Medicine of Guangzhou Women and Children's Medical Center. According to the embryo developmental days and transfer blastocyst numbers, all patients were divided into three groups: double high-quality cleavage embryo transfer of day 3 (n=508), single blastocyst transfer of day 5(n=47), double blastocyst transfer of day 5(n=108). The clinical outcomes were compared. Results The clinical pregnancy rate of the double blastocyst transfer of day 5 was higher than the other two groups,and the differences were statistically significant(P＜0.05). However, there was no statistical difference between the single blastocyst transfer of day 5 and the double high-quality cleavage embryo transfer of day 3(P＞0.05). The multiple pregnancy rate of the single blastocyst transfer of day 5 was lower than the other two groups, and the differences were statistically significant (P＜0.001),and that of the double high-quality cleavage embryo transfer of day 3 was even lower than that of the double blastocyst transfer of day 5,and the difference was statistically significant(P＜0.05). The implanting rate of the double high-quality cleavage embryo transfer of day 3 was lower than the other two groups, and the differences were statistically significant (P＜0.05;P＜0.001),but there was no statistical difference between the single blastocyst transfer of day 5 and the double blastocyst transfer of day 5 (P＞0.05). However, the early miscarriage rate and the ectopic pregnancy rate did not exhibit statistical differences (P＞0.05). Conclusion Single blastocyst transfer of day 5 can ensure clinical pregnancy rate and implantation rate while effectively reducing multiple pregnancy in the women undergoing the first frozen-thawed cycles of under 35 years old.