简化玻璃化胚胎复温方案：不同形态与发育阶段适用性分析
该回顾性队列研究纳入2024年1–12月单中心1501个单胚胎移植周期（150个卵裂期胚胎，1351个囊胚），比较传统三步法与简化两步法、一步法复温的结局。结果显示卵裂期胚胎各方案存活率均100%，囊胚存活率与持续妊娠率在三组间无显著差异，且在各发育阶段、形态质量和成囊日亚组中一致。
要点
- 简化一步法或两步法复温可用于不同发育阶段和形态质量的玻璃化胚胎。
- 囊胚复温后存活率和持续妊娠率在三步法、两步法、一步法间无显著差异。
- 亚组分析显示简化方案在囊胚发育阶段、形态质量和成囊日各层间结果一致。
核心结论
- 简化一步法或两步法复温方案对玻璃化人胚胎有效，且不受发育阶段、形态质量或成囊日影响。
研究设计与样本
- 单中心回顾性队列研究，分析2024年1–12月1501个单胚胎移植周期，含150个卵裂期胚胎和1351个囊胚。
- 比较传统三步法（n=742）、简化两步法（n=461）和简化一步法（n=298），囊胚另行多因素逻辑回归和亚组分析。
主要发现
- 卵裂期胚胎三组存活率均为100%，持续妊娠率分别为11.1%、12.5%、10.8%（P=1.0000）。
- 囊胚三组复温后存活率分别为100%、99.3%、99.6%（P=0.1112），持续妊娠率分别为47.7%、46.2%、43.9%（P=0.5765）。
- 囊胚亚组中，扩张囊胚持续妊娠率分别为49.6%、49.5%、49.1%（P=0.9950），优质囊胚分别为52.1%、51.6%、48.4%（P=0.6390）。
关键数值与推荐
- 传统三步法：解冻液1分钟、稀释液2分钟、洗涤液3分钟。
- 简化两步法：解冻液1分钟、稀释液2分钟；简化一步法：解冻液1分钟。
临床怎么用
- 临床可考虑采用简化一步法或两步法复温玻璃化胚胎，以简化操作流程。
- 简化方案适用于不同发育阶段、形态质量和成囊日的胚胎，无需因这些因素改变复温策略。
局限性
- 本研究为单中心回顾性队列研究，结果需前瞻性多中心验证。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
RESEARCH QUESTION: Is a simplified one- or two-step warming protocol effective and safe for vitrified human embryos across various developmental stages, morphological qualities, and days of blastulation? DESIGN: This retrospective cohort study, conducted at a single IVF centre, analysed 1501 single-embryo transfer cycles (150 cleavage-stage embryos, 1351 blastocysts) performed between January and December 2024. Outcomes were compared between a conventional three-step protocol (thawing solution for 1 min, dilution solution for 2 min and washing solution for 3 min; n = 742) and simplified protocols: two-step (thawing solution for 1 min and dilution solution for 2 min; n = 461) and one-step (thawing solution for 1 min; n = 298). Separate analyses were conducted for cleavage-stage embryos and blastocysts. For blastocysts, a multivariable logistic regression and subgroup analyses were further performed based on developmental stage, morphological quality, and day of blastulation. RESULTS: For cleavage-stage embryos, all protocols resulted in 100% survival and comparable ongoing pregnancy rates (11.1% for three-step protocol, 12.5% for two-step protocol, 10.8% for one-step protocol; P = 1.0000). For blastocysts, the post-warming survival rate (100%, 99.3%, 99.6%; P = 0.1112) and ongoing pregnancy rate (47.7%, 46.2%, 43.9%; P = 0.5765) were comparable among the three protocols, including when confounders were considered. This equivalence was observed consistently across all subgroups, including developmental stage (full blastocyst: 43.2%, 39.6%, 33.7%, P = 0.3111; expanded blastocyst: 49.6%, 49.5%, 49.1%; P = 0.9950), morphological quality (poor grade: 27.5%, 23.5%, 23.4%, P = 0.7636; good grade: 52.1%, 51.6%, 48.4%, P = 0.6390), and day of blastulation (day 5: 52.7%, 52.9%, 50.3%, P = 0.8234; day 6: 34.4%, 28.5%, 27.4%, P = 0.4088). CONCLUSIONS: Simplified one- or two-step warming protocols are effective for vitrified human embryos, regardless of developmental stage, morphological quality, or day of blastulation.
引用
- Shioya M, Okabe-Kinoshita M, Koga K, et al. Simplified warming of vitrified human embryos: comprehensive analysis of diverse morphological qualities and developmental stages. Reprod Biomed Online. 2026. PMID: 42435579. doi:10.1016/j.rbmo.2026.105799
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。