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目的:探讨囊胚培养与囊胚移植在临床上的应用价值。方法:将卵裂期胚胎延长体外培养至囊胚期,观察囊胚形成率及质量,分析卵裂期胚胎质量与囊胚形成的关系及囊胚形成与临床妊娠的关系。结果:387例患者3 513个胚胎进行囊胚培养,共获得1 489个囊胚,囊胚形成率为42.35%。Ⅰ￣Ⅱ级胚胎囊胚形成率显著高于Ⅲ￣Ⅳ级胚胎(P<0.01);移植第5、6、7日囊胚临床妊娠率比较差异有显著统计学意义(P<0.01),囊胚冷冻移植异位妊娠发生率显著低于卵裂期冷冻胚胎移植(P<0.01)。结论:①对一些形态学上认为无冷冻价值的非优质胚胎也可延长体外培养时间培养至囊胚,筛选出具有发育潜能的胚胎,从而可以最大限度地利用胚胎,减少患者的损失;②移植第5日形成的囊胚可获得更高的妊娠率;③囊胚移植可有效防止异位妊娠的发生。
Objective: To explore the clinical value of blastocyst culture and blastocyst transplantation in clinical application. METHODS: The cleavage stage embryos were cultured in vitro until the blastocyst stage. The blastocyst formation rate and quality were observed. The relationship between blastocyst stage blastocyst formation and blastocyst formation, blastocyst formation and clinical pregnancy were analyzed. Results: A total of 1 513 blastocysts were obtained from 3 513 embryos of 387 patients. The blastocyst formation rate was 42.35%. The blastocyst formation rate of grade Ⅰ ~ Ⅱ embryos was significantly higher than that of grade Ⅲ ~ Ⅳ embryos (P <0.01). The clinical pregnancy rates of blastocysts on the 5th, 6th and 7th days after transplantation were significantly different (P <0.01) The incidence of ectopic pregnancy with frozen embryo transfer was significantly lower than that of frozen embryo transfer with cleavage stage (P <0.01). Conclusion: ①For some non-high-quality embryos which are morphologically considered as non-freezing, they can be prolonged in vitro to culture to blastocysts and embryos with developmental potential can be screened to maximize the use of embryos and reduce the loss of patients. ②Transplantation Blastocysts formed on the 5th can get a higher pregnancy rate; ③ blastocyst transplantation can effectively prevent the occurrence of ectopic pregnancy.