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目的 探讨不同受精方式对D3非优质胚胎继续体外培养的囊胚形成情况的影响。方法 回顾性分析2015年1月至2023年1月于我院生殖医学中心行常规体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕治疗，且在胚胎培养的D3未形成优质胚胎的1 686个周期的临床资料。根据最终是否形成囊胚将患者分为囊胚形成组(n=251)和囊胚未形成组(n=1 435),又根据是否形成优质囊胚将囊胚形成组分为两个亚组：优质囊胚组(n=41)和非优质囊胚组(n=210),比较各组间患者的一般资料，并采用单因素分析影响囊胚形成率及优质囊胚形成率的相关因素，采用多因素Logistic回归方程分析影响囊胚形成率及优质囊胚形成率的因素。结果 囊胚未形成组的女方平均年龄、不孕年限、继发不孕比例、ICSI受精占比和基础卵泡刺激素(bFSH)水平均显著高于囊胚形成组(P<0.05)。在囊胚形成组中，优质囊胚组基础黄体生成素(bLH)显著低于非优质囊胚组(P<0.05)。单因素结果显示，女方年龄<35岁、D3胚胎细胞数为6个、D3细胞数为奇数、D3碎片率≤15%、受精方式采用IVF的胚胎的囊胚形成率更高(P<0.05);D3细胞数≥6个、D3碎片率≤15%、受精方式采用IVF的胚胎的优质囊胚形成率更高(P<0.05)。多因素Logistic回归在校正女方年龄、D3胚胎细胞数、D3胚胎碎片率等混杂因素后，结果显示，受精方式是D3非优质胚胎囊胚形成率和优质囊胚形成率的独立影响因素(P<0.05)。结论 与ICSI方式获得的D3非优质胚胎相比，采取IVF方式获得的D3非优质胚胎具有较高的囊胚形成率和优质囊胚形成率。
Abstract：Objective:To explore the impact of different fertilization modes on the formation of blastocyst in patients with no high-quality embryos on the third day(D3) of embryo culture.Methods:A retrospective analysis of clinical data of 1 686 patients who underwent conventional IVF/ICSI-ET treatment and with no high-quality embryos on D3 of embryo culture at Reproductive Medicine Center of The First Affiliated Hospital of Zhengzhou University from January 2015 to January 2023. Patients were divided into blastocyst formation group(n=251) and non blastocyst formation group(n=1 435) based on whether blastocyst was ultimately formed. And based on whether high-quality blastocyst was formed, the blastocyst formation group was further divided into two subgroups: the high-quality blastocyst group(n=41) and the non high-quality blastocyst group(n=210). The general characteristics of patients in each group were compared, and the relevant factors affecting blastocyst and high-quality blastocyst formation were analyzed with univariate analysis and multivariate logistic regression.Results:Compared with blastocyst formation group, the average age, the duration of infertility, the proportion of secondary infertility and ICSI fertilization as well as basal FSH(bFSH) level in non blastocyst formation group were significantly higher(P<0.05). The basal LH(bLH) in the high-quality blastocyst group was significantly lower than that in the non high-quality blastocyst group(P<0.05). The results of the univariate analysis showed that embryos with less than 35 of maternal age, 6 D3 embryo cells, an odd number of D3 cells, not more than 15% of D3 fragmentation rate, and IVF had a higher blastocyst formation rate(P<0.05). After adjusting for confounding factors such as the age of the female partner, the number of D3 embryo cells, and the rate of D3 embryo fragmentation using multivariate logistic regression, the results showed that the fertilization method was an independent influencing factor of the formation rate of D3 non high-quality embryos and high-quality embryos(P<0.05).Conclusions:For patients with no high-quality embryos on D3 of embryo culture, IVF embryos have a higher rate of blastocyst formation and high-quality blastocyst formation than ICSI ones.
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基本信息:
中图分类号:R714.8
引用信息:
[1]谢中亚,陈一文,石森林,等.不同受精方式对非优质卵裂期胚胎囊胚形成的影响[J].生殖医学杂志,2024,33(06):715-721.
基金信息:
国家自然科学基金面上项目(82171658); 河南省医学科技攻关项目(SBGJ202102094)
2023-10-18
2023
2023-12-07
2024-04-30
2024
1
2024-06-15
2024-06-15