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目的探讨不孕患者自身因素以及体外培养Day3胚胎形态学指标与囊胚形成之间的相关性。方法将1894个体外受精-胚胎移植治疗周期的Day3移植后剩余的16 191个胚胎进行囊胚培养至Day6,分析女方年龄、不孕因素、体外受精方式、DAY3胚胎卵裂球数目以及碎片程度与囊胚形成的关系。结果女方年龄≤30岁组、31-35岁组和≥36岁组之间的囊胚形成率分别为31.38%(2315/7376)、29.42%(1773/6025)和22.15%(618/2790),并且组与组之间有统计学差异,P<0.05;不明原因不孕组的囊胚形成率26.41%(904/3423)低于排卵障碍组29.84%(588/1970)、盆腔输卵管组29.28%(2124/7255)、子宫内膜异位组30.26%(361/1193)和男方因素组31.02%(729/2350),且P<0.05;常规体外受精组的囊胚形成率29.25%(3234/11055)与卵胞浆单精子注射组27.69%(1472/5136)无统计学差异;DAY3卵裂球数目≥7个组、5-6个组和≤4个组的囊胚形成率分别为47.78%(1035/2166)、31.53%(2079/6594)和21.42%(1592/7431),并且组与组之间有统计学差异,P<0.05;DAY3碎片程度≤10%组、11-30%组和≥31%组的囊胚形成率分别为33.54%(2719/8106)、25.99%(1951/7507)和6.23%(36/578),并且组与组之间有统计学差异,P<0.05。结论女方年龄、不明原因不孕以及Day3胚胎形态学指标卵裂球数目和碎片程度都是影响囊胚形成的重要因素。在保证囊胚体外培养条件的基础上,综合评价患者自身条件以及胚胎发育情况,可以为临床合理运用囊胚培养方案提供依据。
Objective To investigate the self-factors of infertility patients and the relationship between morphology of Day3 embryos and blastocyst formation in vitro. Methods The remaining 16 191 embryos after 1894 in vitro fertilization and embryo transfer cycles were cultured in blastocysts to Day 6. The age, infertility factors, in vitro fertilization, the number of blastomeres in DAY3 embryos, The relationship between blastocyst formation. Results The blastocyst formation rates of women aged ≤30 years, 31-35 years and ≥36 years were 31.38% (2315/7376), 29.42% (1773/6025) and 22.15% (618/2790) respectively, (P <0.05). The rate of blastocyst formation in unexplained infertility group was 26.41% (904/3423) lower than that in ovulation disorder group (29.84%, 588/1970), pelvic fallopian tube group (29.28%) % (2124/7255), 30.26% (361/1193) in endometriosis group and 31.02% (729/2350) in male factor group, P <0.05. The blastocyst formation rate in routine IVF group was 29.25% (3234% / 11055) and 27.69% (1472/5136) in the oocyte cytosolic sperm injection group. The blastocyst formation rates of DAY3 blastomeres≥7, 5-6 and ≤4 groups were 47.78% (1035/2166), 31.53% (2079/6594) and 21.42% (1592/7431), respectively, and there was a significant difference between the two groups (P <0.05) The blastocyst formation rates were 33.54% (2719/8106), 25.99% (1951/7507) and 6.23% (36/578) in the% and 31% groups, respectively, and there was a significant difference between the groups <0.05. Conclusion Female age, unexplained infertility and the morphological index of Day3 embryos are the number of blastomeres and the degree of fragmentation are both important factors that affect blastocyst formation. On the basis of ensuring the conditions of in vitro culture of blastocysts and comprehensively evaluating their own conditions and embryonic development, it is possible to provide a basis for clinical application of blastocyst culture programs.