不同受精方式对第六天囊胚解冻移植周期妊娠结局的影响

刘燕; 王辉田; 李涛

doi:10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0422

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不同受精方式对第六天囊胚解冻移植周期妊娠结局的影响

临床研究 | 更新时间：2024-02-19

- 不同受精方式对第六天囊胚解冻移植周期妊娠结局的影响
- Effect of Insemination Methods on Pregnancy Outcomes of Day 6 Blastocyst Transfer in Frozen Cycles
- 中山大学学报（医学科学版） 2023年44卷第4期页码：704-711
- 作者机构：
  
  中山大学附属第三医院生殖中心，广东广州 510630
- 作者简介：
  
  刘燕，研究方向：生殖医学，E-mail：lanfu12@126.com
- 基金信息：
- DOI：10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0422
  中图分类号： R714.8
- 纸质出版日期：2023-07-20，
  
  收稿日期：2023-02-14，
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刘燕,王辉田,李涛.不同受精方式对第六天囊胚解冻移植周期妊娠结局的影响[J].中山大学学报（医学科学版）,2023,44(04):704-711.

LIU Yan,WANG Hui-tian,LI Tao.Effect of Insemination Methods on Pregnancy Outcomes of Day 6 Blastocyst Transfer in Frozen Cycles[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(04):704-711.
刘燕,王辉田,李涛.不同受精方式对第六天囊胚解冻移植周期妊娠结局的影响[J].中山大学学报（医学科学版）,2023,44(04):704-711. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0422.

LIU Yan,WANG Hui-tian,LI Tao.Effect of Insemination Methods on Pregnancy Outcomes of Day 6 Blastocyst Transfer in Frozen Cycles[J].Journal of Sun Yat-sen University(Medical Sciences),2023,44(04):704-711. DOI： 10.13471/j.cnki.j.sun.yat-sen.univ(med.sci).2023.0422.

摘要

目的

比较常规体外受精（IVF）和卵胞质内单精子注射（ICSI）两种不同授精方式对解冻移植第六天（D6）囊胚患者妊娠结局的影响。

方法

回顾性队列研究分析中山大学附属第三医院生殖中心2018年1月至2020年4月期间解冻移植第六天囊胚移植患者的临床资料，按受精方式分为常规IVF组（446例）和ICSI受精组（200例）。按是否有第五天（D5）囊胚移植史，分为仅有D6囊胚冷冻及移植的患者，以及有D5囊胚移植史的患者。比较两组患者基本资料、囊胚质量及妊娠结局。

结果

IVF组和ICSI组患者BMI，不孕年限，基础FSH差异均无统计学意义（

0.05）。ICSI组患者年龄小于IVF组患者，原发性不孕的比例高于常规IVF组，获卵数和正常受精卵子数高于常规IVF受精组（

0.001）。常规IVF组五期和六期囊胚比例高于ICSI组（21.6 %

vs.

3.14 %，

0.001）。ICSI组ICM评分为A级的囊胚高于IVF组（23.8 %

vs.

14.3 %，

= 0.01）。ICSI组HCG阳性率和临床妊娠率均高于IVF组（65.5 %

vs.

48.4 %，

0.001； 56 %

vs.

41.3 %，

= 0.001），ICSI组胚胎种植率和活产率也高于常规IVF组（43.8 %

vs.

30.9 %，

0.001； 43.0 %

vs.

31.8 %，

= 0.006）。校正两组间年龄、获卵数等影响因素后，ICSI组临床妊娠率仍高于常规IVF组（OR：1.590， 95 % CI： 1.030， 2.455，

= 0.036）。ICSI组出生婴儿体质量低于IVF组（

= 0.016），早产率、性别比与分娩方式在两组间差异无统计学意义。

结论

ICSI受精的D6囊胚解冻移植后的临床妊娠率高于常规IVF受精的D6囊胚，活产率有升高的趋势，可能与IVF与ICSI病人导致囊胚发育慢的因素不同有关。ICSI受精的D6囊胚解冻移植后相对好的妊娠结局，可在一定程度上弥补ICSI周期囊胚发育相对较慢导致的妊娠结局的差异。

Abstract

Objective

To compare the effects of two different insemination methods， conventional in vitro fertilization （IVF） and intracytoplasmic sperm injection （ICSI）， on pregnancy outcomes in patients with frozen-thawed D6（day 6） blastocyst transfer.

Methods

A retrospective cohort study was conducted to analyze the clinical data of patients with thawed D6 blastocyst transfer between January 2018 and April 2020 at the Fertility Center of the Third Hospital of Sun Yat-sen University， divided into conventional IVF group （446 cycles ） and ICSI fertilization group （200 cycles） according to the fertilization method. Patients were divided into those with a history of D5（day 5） blastocyst transfer and those without. The patients’ general characteristics， blastocyst quality， and pregnancy outcomes of the two groups were compared.

Results

BMI， years of infertility， and basal FSH were not statistically significant in the IVF and ICSI groups （

0.05）. Regardless of the history of D5 transfer， patients in the ICSI group were younger than those in the IVF group （

0.001）， the proportion of primary infertility was significantly higher in the ICSI group （

0.001）， and the number of oocytes obtained and the number of normally fertilized oocytes in the ICSI group were higher than those in the conventional IVF fertilization group （

0.001）. The proportion of stage V and Ⅵ blastocysts was significantly higher in the conventional IVF group than in the ICSI group （21.6 %

vs.

3.14 %，

0.001）. High-quality blastocysts with an ICM score of A were significantly higher in the ICSI group than in the IVF group （23.8 %

vs.

14.3 %，

= 0.01）. The HCG-positive and clinical pregnancy rates were significantly higher in the ICSI group than in the IVF group （65.5 %

vs.

48.4 %，

0.001； 56 %

vs.

41.3 %，

= 0.001）， and embryo implantation and live birth rates were also higher in the ICSI group than in the conventional IVF group （43.8 %

vs.

30.9 %，

0.001； 43.0 %

vs.

31.8 %，

= 0.006）. After correcting for age and number of oocytes obtained between the two groups， the clinical pregnancy rate was still significantly higher in the ICSI group than in the conventional IVF group （OR： 1.590， 95 % CI： 1.030， 2.455，

= 0.036）. Infant birth weight was lower in the ICSI group than in the IVF group （

= 0.016）， and the differences in preterm birth rate， sex ratio， and mode of delivery were not statistically significant between the two groups.

Conclusions

Clinical pregnancy and live birth rates after thawing and transfer of D6 blastocysts fertilized by ICSI are higher than those of D6 blastocysts fertilized by conventional IVF， which may be related to the different factors contributing to the slow development of blastocysts in patients who received different fertilization methods. The relatively good pregnancy outcome after the transfer of thawed D6 blastocysts fertilized by ICSI may compensate to some extent for the difference in pregnancy outcome due to the relatively slow blastocyst development and a relatively higher proportion of D6 blastocysts after ICSI fertilization in male infertility patients.

关键词

第6天囊胚体外受精-胚胎移植卵胞质内单精子注射妊娠率活产率

Keywords

D6 blastocystin vitro fertilization-embryo transferintracytoplasmic sperm injectionclinical pregnancy ratelive birth rate

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