冻融胚胎序贯移植策略改善反复胚胎种植失败的应用及内在机制

The Application and Underlying Mechanisms of Sequential Frozen-Thawed Embryo Transfer Strategy in Improving Embryo Implantation Failure

摘要: 胚胎种植失败，尤其是多次失败的移植周期，不仅给患者及家庭带来沉重的精神压力、情感创伤和巨大的经济成本。针对胚胎种植失败并非单一疾病，而是由胚胎因素(遗传学异常、发育潜能差)、子宫内膜容受性因素(种植窗移位、免疫微环境异常、解剖结构异常)以及两者同步性共同作用的结果。序贯移植是卵裂胚胎移植和囊胚移植的结合，可通过最大化“着床窗口”来提高子宫内膜容受性。将第一个胚胎移入子宫腔，可以启动与子宫内膜的引发分子层面的相互作用，从而促进第二个胚胎的着床。通过其“种植窗”和“优化胚胎–内膜对话”的双重理论优势，为应对反复种植失败这一临床挑战提供了新的理论视角和潜在解决方案。虽然目前的临床证据需要进一步巩固，但这种方法有望改善反复种植失败(Recurrent Implantation Failure, RIF)患者的妊娠结局，为临床优化RIF治疗方案提供理论依据和实践参考。

Abstract: Embryo implantation failure, particularly after multiple unsuccessful transfer cycles, not only imposes significant psychological stress and emotional distress on patients and their families but also leads to substantial financial burdens. Recurrent Implantation Failure (RIF) is not a single disease entity but rather a complex condition resulting from the combined effects of embryonic factors (e.g., genetic abnormalities, poor developmental potential), endometrial receptivity factors (e.g., displaced window of implantation, immune microenvironment dysregulation, anatomical abnormalities), and asynchrony between the embryo and endometrium. Sequential embryo transfer, which combines the transfer of cleavage-stage embryos and blastocysts, aims to enhance endometrial receptivity by maximizing the “implantation window.” The initial transfer of an embryo into the uterine cavity may initiate molecular cross-talk with the endometrium, thereby facilitating the implantation of subsequent embryos. By leveraging the dual theoretical advantages of extending the implantation window and optimizing embryo-endometrial dialogue, this strategy offers a promising novel approach to addressing the clinical challenges of Recurrent Implantation Failure (RIF). Although current clinical evidence requires further consolidation, this approach holds promise for improving pregnancy outcomes in patients with RIF.