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- 2018
激光人工皱缩对囊胚玻璃化冷冻后妊娠结局的影响
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Abstract:
摘要：目的 探讨囊胚激光人工皱缩预处理方法(LAS)在人囊胚玻璃化冻融中的应用效果。方法 选取2014年1月1日至2015年12月31日期间的患者行解冻囊胚周期3859例。根据是否进行激光人工皱缩将其分为激光皱缩组(3176例)和未皱缩组(683例)，进一步根据不同年龄分为<36岁组和≥36岁组，主要比较指标：复苏率、临床妊娠率、种植率。结果 激光皱缩组的复苏率、临床妊娠率、种植率分别为97.32%(5453/5603)、66.81%(2118/3170)、53.55%(2912/5438)；未皱缩组的复苏率、临床妊娠率、种植率分别为95.13%(1173/1233)、62.70%(427/681)、49.74%(582/1170)；二组相比均有统计学差异(P<0.05)。进一步的亚组分析显示，<36岁激光皱缩组的复苏率高于未皱缩组[97.27%(4887/5024) vs. 95.33%(1040/1091)] (P<0.05)。≥36岁激光皱缩组的复苏率、生化妊娠率高于对照组[97.75%(566/579) vs. 93.66%(133/142)]、[65.45%(216/330) vs. 50.65%(39/77)] (P<0.05)。激光皱缩组和对照组的取消移植率分别为0.19%和0.29%，两组比较差异无统计学意义(P>0.05)。结论 冷冻前采用激光人工皱缩技术可提高囊胚解冻后的复苏率、临床妊娠率、种植率。
ABSTRACT: Objective To investigate the effect of laser artificial shrinkage (LAS) on pregnancy outcome in vitrification of human expanded blastocysts. Methods We selected 3859 frozen-thawed blastocyst-stage embryo transfers from January 2014 to December 2015. The transfers were divided into LAS group (n=3176) and non-LAS group (n=683), which were then subdivided into <36y subgroup and ≥36y subgroup according to their age. Main outcomes measures were thawing rate, implantation rate and clinical pregnancy rate. Results Thawing rate, clinical pregnancy rate and implantation rate were 97.32% (5453/5603), 66.81% (2118/3170), and 53.55% (2912/5438) in LAS group. In non-shrink group, they were 95.13% (1173/1233), 62.70% (427/681), and 49.74% (582/1170), which did not significantly differ from those in the former group (P<0.05). Further analysis of the subgroups showed that thawing rate was significantly higher in LAS group than in non-shrink group of patients <36y (97.27% vs. 95.33%; P<0.05). Thawing rate and biochemical pregnancy rate were significantly higher in LAS group than in non-shrink group in patients ≥36y (97.75% vs. 93.66%; 65.45% vs. 50.65%, P<0.05). Cancellation rate was not significantly different between the two groups (0.19% vs. 0.29%, P>0.05). Conclusion LAS technique can increase thawing rate, clinical pregnancy rate and implantation rate before cryopreservation of blastocysts
| [1] | WIRLEITNER B, SCHUFF M, STECHER A, et al. Pregnancy and birth outcomes following fresh or vitrified embryo transfer according to blastocyst morphology and expansion, stage, and culturing strategy for delayed development[J]. Hum Reprod, 2016, 31(8):1685-1695. |
| [2] | LANDUYT LV, POLYZOS NP, MUNCK ND, et al. A prospective randomized controlled trial investigating the effect of artificial shrinkage (collapse) on the implantation, potential of vitrified blastocysts[J]. Hum Reprod, 2015, 30(11):2509-2518. |
| [3] | HUANG CC, LEE TH, CHEN SU, et al. Successful pregnancy following blastocyst cryopreservation using super-cooling ultra-rapid vitrification[J]. Hum Reprod, 2005, 20(1):122-128. |
| [4] | MUKAIDA T, OKA C, GOTO T, et al. Artificial shrinkage of blastocoeles using either a micro needle or a laser pulse prior to the cooling steles of vitrification improves survival rate and pregnancy outcome of vitrified human blastocysts[J]. Hum Reprod, 2006, 21(12):3246-52. |
| [5] | 张宁媛，孙海翔，胡娅莉，等. 3种囊腔人工皱缩技术在小鼠扩张期囊胚玻璃化冷冻中的比较研究[J]. 中华男科学杂志, 2009, 15(3):228-231. |
| [6] | LANDUYT LV, POLYZOS NP, MUNCK ND, et al. A prospective randomized controlled trial investigating the effect of artificial shrinkage (collapse) on the implantation, potential of vitrified blastocysts[J]. Hum Reprod, 2015, 30(11):2509-2518. |
| [7] | PAOLO EMANUELE LEVI-SETTI, FRANCESCA MENDUNI, et al. Artificial shrinkage of blastocysts prior to vitrification improves pregnancy outcome: Analysis of 1028 consecutive warming cycles[J]. J Assist Reprod Genet, 2016, 33(4):461-466. |
| [8] | 刘艳丽，李真，王文英，等. 不同移植方案在不同获卵数患者中的临床结局分析[J]. 西安交通大学学报(医学版), 2015, 36(6):824-828. |
| [9] | 薛侠，施文浩，师娟子，等. D5选择性的单囊胚移植和双囊胚胎移植妊娠结局比较[J]. 生殖医学杂志, 2014, 23(4):276-279. |
| [10] | BRINSDEN PR. A textbook of in vitro fertilization and assisted reproduction[M]. New York: The Parthenon Publishing Group Inc, 1999:1996. |
| [11] | HARDAISON T, CAISANDER G, SJOGREN A et al. A morphological and chromosomal study of lastocysts developing from morphologically suboptimal human pre-embryos compared with control blastocysts[J]. Hum Reprod, 2003, 18(2):399-407. |
| [12] | 冯贵雪，张波，周红，等. 冻融周期行单囊胚移植的可行性探讨[J]. 中华妇产科杂志, 2011, 46(12):943-945. |
| [13] | 纪冬梅，章志国，周平，等. 激光皱缩法在囊胚玻璃化冷冻中的应用价值[J]. 生殖与避孕, 2013, 33(11):725-729. |
| [14] | ZECH NH, LEJEUNE B, PUISSANT F, et al. Prospective evaluation of the optimal time for selecting a single embryo for transfer: Day 3 versus day 5[J]. Fertil Steril, 2007, 88(1):244-246. |
| [15] | 黄国宁. 体外受精-胚胎移植实验室技术[M]. 北京：人民卫生出版社, 2012, 30-84. |
| [16] | 庞敏，张坤，孙健，等. 激光人工皱缩在囊胚玻璃化冷冻中的应用[J]. 新疆医学, 2013, 43(9):77-79. |
| [17] | 冯贵雪，张波，舒金辉，等. 人工皱缩囊胚腔对囊胚玻璃化冷冻后妊娠结局的影响[J]. 中华妇产科杂志, 2010, 5(11):838-842. |
