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目的:探讨授精第3日发育迟缓(5~6-细胞)的胚胎冷冻价值及如何提高其利用价值的可行性方案。方法:回顾性分析进行冷冻复苏移植第3日发育迟缓胚胎的124个周期的临床资料,根据不同的复苏移植方案和培养条件,分为第3日冷冻,复苏移植周期提前1 d解冻者(A组,32个周期)、解冻后培养至囊胚再移植组(B组,62个周期)、当日解冻组(C组,30个周期),再与同期新鲜周期第3日发育迟缓行囊胚培养再冷冻复苏囊胚(复苏囊胚组,D组)的58个周期比较。结果:1各组在女方年龄、不孕年限、排卵日子宫内膜厚度、移植日激素水平等方面无统计学差异(P>0.05)。2D组的周期临床妊娠率(55.4%)和种植率(42.2%)都高于其他组(P<0.05)。A组和B组的周期取消率(12.5%和35.5%)均高于其他组(P<0.05),B组的临床妊娠率(40.0%)高于C组(33.7%)(P<0.05),但与A组(39.3%)比较无统计学差异(P>0.05)。结论:1授精第3日5~6-细胞胚胎可以通过新鲜周期延长体外培养时间至第6日,获得囊胚后再进行冷冻复苏,可以得到更好的临床结局。2对于胚胎少的患者,可以在患者知情同意下选择5~6-细胞胚胎第3日直接冷冻,复苏周期提前解冻来挑选具有发育潜能的胚胎进行移植。
Objective: To investigate the embryo freezing value and the feasibility of increasing its utilization value on the 3rd day of fertilization (5 ~ 6-cell). Methods: The clinical data of 124 cycles of embryonic developmentally retarded embryos on day 3 were retrospectively analyzed. According to different resuscitation protocols and culture conditions, the patients were divided into three groups: (32 cycles). After thawing, the cells were cultured in blastocyst replantation group (group B, 62 cycles), thawed on the same day (group C, 30 cycles), and then synchronized with blastocyst culture 58 cycles of cryopreserved blastocysts (blastocyst group, D group) were compared. Results: 1 There was no significant difference in the age of female, the duration of infertility, the endometrial thickness of ovulation day and the level of hormone on transplantation (P> 0.05). The cycle clinical pregnancy rate (55.4%) and implantation rate (42.2%) in 2D group were higher than those in other groups (P <0.05). The cycle cancellation rates in group A and group B were significantly higher than those in other groups (12.5% vs 35.5%, P <0.05). The clinical pregnancy rate in group B was significantly higher than that in group C (40.0% vs 33.7%, P <0.05) , But there was no significant difference compared with group A (39.3%) (P> 0.05). CONCLUSIONS: 1 5 ~ 6-cell embryos on the third day of fertilization can prolong the in vitro culture time to the sixth day through the fresh cycle, get the blastocysts and then undergo the freezing and resuscitation, and get a better clinical outcome. 2 For patients with few embryos, 5-6-day-old embryos can be directly frozen on the third day with informed consent of the patients, and thawed in the recovery cycle to select embryos with developmental potential for transplantation.