Study On Influence Factors And Clinical Application Value Of Blastocysts Cultured From Poor Quality Embryos On Day 3

ObjectivesTo study the clinical and laboratory influence factors on blastulation from Day3 poor quality embryos,and to discuss the clinical application value of blastocysts derived from Day3 poor quality embryos through analyzing the clinical outcomes after frozen embryo transplantation.Methods374 cycles of assisted reproductive technology in Gansu Provincial Maternity and Child-care Hospital(GMCH)from January 2012 to December 2014 were selected.302 cycles of them were tubal factors while 72 of them were uncleared infertility.Women's age,infertility years,infertility type,insemination methods,total use of Gn,days of Gn use,estradiol on the day of human chorionic gonadotropin injection,luteinizing hormone on the day of human chorionic gonadotropin injection,the dominant follicular diameter on the day of human chorionic gonadotropin injection,number of mature oocytes and basal hormone levels of luteinizing hormone(bLH),estradiol(bE2)and follicule-stimulating hormone(bFSH)were analyzed.Results1.The blastulation rate of 1938 Day3 poor quality embryos from 374 cycles was 49.12%(952/1938).the high-quality blastocysts formation rate was 30.44%(590/1938).2.Thewomen's age,infertility years,days of Gn use,total use of Gnand bFSH in the group of blastulation group were significantly lower than no-blastulation group(P<0.05),but the estradiol on the day of human chorionic gonadotropin injection,bLH,bE2 and the number mature oocytes in HCG was statistically higher(P<0.05).3.The womens' s age,infertility years,total use of Gn,bFSH of high-quality blastulation group were statistically lower than no high-quality blastulation group(P<0.05),while the estradiol on the day of human chorionic gonadotropin injection,bE2 and the number of mature oocytes were significantly higher(P<0.05).4.There was a negative correlation between blastocytes formation and age,infertility years,days of Gn use,Gn total dose,bFSH,the difference was statistically significant(P<0.05).There was a significant correlation between high quality blastocytes formation and age,infertility,Gn days,Gn total dose(P<0.05).There was a positive correlation between the number of mature embryos and blastocytes formation(P<0.05).There was a positive correlation between the number of mature oocytes and the high quality blastocysts formation(P<0.05).5.The blastulation rate and high qualityblastulation rate on the groups of <35 years and<5 years infertility were all significantly higher than the groups ?35 years and ? 5 years infertility(P<0.05),But there was no statistical difference between two groups of primary and secondary infertility(P>0.05).6.The high quality blastulation rate in the group of the bE2 on 0.11<to<0.29 nmol/L was significantly higher than the group ?0.11 nmol/L(P<0.0167).Both blastulation rate and high quality blastulation rate had no significant difference between any two groups on b LH and bFSH(P>0.05).7.The blastulation rate and high quality blastulation rate in the group of the total use of Gn on ?2250IU were significantly lower than other two groups(1125<to<2250IU and ?1125IU)(P<0.0167).The blastulation rate in the group of Gn days <10 was significantly higher than?10 days(P<0.05)while there was no significant difference on high quality blastulation rate(P>0.05).The blastulation rate in the groups of the estradiol on the day of human chorionic gonadotropin injection on 12.81< to< 18.30 nmol/L and?18.30nmol/L were all significantly higher(P<0.0167)than ?12.81nmol/L.There was no significant difference in blastulation rate and high quality blastulation rate between any two groups of LH levels on the day of human chorionic gonadotropin injection(P>0.05).8.The blastulationrate and high quality blastulationrate of IVF were significantly higher than ICSI(P<0.05).9.With the increase of the mature oocytes,the blastulation rate was significantly improved as well.But to high quality blastulation,only statistical difference was shown in the grops between ?15 and ?4(P<0.0167).10.It was found that the blastulation rate was significantly lower than 18<to<23mm group when the dominant follicle diameter ?23mm on day of HCG injection(P<0.0167).But the high quality blastulation rate of ?23mm group was significantly lower than the other two groups(P<0.0167).11.The clinical pregnancy rate(45.24%)of blastocysts transplantation derived from Day3 poor quality embryos were significantly lower than control(P<0.05).Howerer,there was no significant difference between two groups on abortion rate(P>0.05).Conclusions1.Day3 poor quality embryos have potential to be blastocytes after further clutivation.2.It was showed that maternal age,infertility years,total use of Gn,Gn days and ovarian reserve capacity could affect the blastulation of Day3 poor quality embryos.For the patients who had better ovarian reserve capacity,less than 35 years maternal age,less than 5 years infertility history,better Gn response as well as those patients who was used IVF to insemination,they would have much higher rate on blastulation and high quality blastulation.3.For it would have acceptable clinical pregnancy rate and relatively lower abortion rate after single blastocyst transplantation,Day3 poor quality embryos still have a certain clinical value to patients.