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目的分析复苏周期中移植非优良胚胎的妊娠结局,探讨非优良胚胎的最佳移植策略。方法回顾性分析非优良胚胎冻融移植治疗患者共286个周期的临床资料。根据复苏前胚胎情况分为生长迟缓组(A组)和胚胎碎片较多组(B组),A组再按其不同的复苏方案和培养条件,分为A1组(提前解冻亚组,26个周期)、A2组(囊胚培养亚组,52个周期)及A3组(对照当天解冻亚组,30个周期),同样,B组也分为B1组(32个周期)、B2组(42个周期)和B3组(104个周期)。比较A1、A2、A3、B1、B2、B3各组间的一般情况、复苏率、周期取消率、临床妊娠率、种植率等方面的差异。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)。(2)A1、A2、B1和B2组周期取消率(15.4%、42.3%、15.6%和23.8%)均高于A3和B3组(0%,0%)(P<0.05)。A3组和B3组的临床妊娠率(36.7%和37.5%)、胚胎植入率(22.8%和20.8%)均低于A1组(40.9%和26.8%)、A2组(43.3%和31.1%)、B1组(40.7%和26.5%)和B2组(43.8%和32.7%)(P<0.05)。结论 (1)对于发育迟缓的冷冻胚胎,最佳的移植方案是通过提前24h解冻选择恢复有丝分裂的胚胎进行移植。(2)对于胚胎碎片较多的冷冻胚胎,最佳的培养移植方案是通过囊胚培养,延长体外培养时间选择最具发育潜能的胚胎进行移植。(3)虽然囊胚培养的取消率高,但是采用囊胚培养移植可以减轻患者的经济负担、缓解患者心理压力。
Objective To analyze the pregnancy outcome of non-good embryo transfer during the resuscitation cycle and to explore the optimal transplantation strategy for non-good embryo. Methods The clinical data of 286 cycles of non-good embryo freeze-thawed transplantation were retrospectively analyzed. According to different resuscitation protocols and culture conditions, group A was divided into group A1 (early thaw subgroup, group 26, group A, group B, group B, group B) Group B was also divided into B1 group (32 cycles), B2 group (42 cycles), Group A2 (blastocyst culture subgroup, 52 cycles) and Group A3 (control group thawed the same day, 30 cycles) Cycles) and B3 (104 cycles). The differences between A1, A2, A3, B1, B2 and B3 in each group were compared in terms of resuscitation rate, cycle cancellation rate, clinical pregnancy rate and implantation rate. Results (1) There was no significant difference in the age of female, the duration of infertility, the endometrial thickness on ovulation day and the level of hormone on transplantation (P> 0.05). (2) The cancellation rates (15.4%, 42.3%, 15.6% and 23.8%) in A1, A2, B1 and B2 groups were higher than those in A3 and B3 groups (0% and 0%, P <0.05). The clinical pregnancy rates (36.7% and 37.5%) and embryo implantation rates (22.8% and 20.8%) in group A3 and group B3 were significantly lower than those in group A1 (40.9% and 26.8%) and group A2 (43.3% and 31.1% , B1 (40.7% and 26.5%) and B2 (43.8% and 32.7%, respectively) (P <0.05). Conclusions (1) For frozen embryos with stunted growth, the best transplantation plan is to transplant mitotic embryos by thawing and thawing in advance. (2) For the frozen embryos with more embryo fragments, the best culture transplant program is to transplant the embryos with the most developmental potential through blastocyst culture and prolonging the culture time in vitro. (3) Although the cancelation rate of blastocyst culture is high, the transplantation of blastocysts can reduce the economic burden of patients and relieve the psychological pressure of patients.