卵裂期形态学评级在选择性单囊胚移植时的参考价值
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摘要
目的研究囊胚发育潜能和新生儿出生情况与其卵裂期D2和D3评级的关系。方法回顾性分析2013年6月至2017年10月340个复苏周期单囊胚移植患者的临床资料,分析不同卵裂期D2和D3评级对囊胚进行玻璃化冷冻复苏后的临床妊娠结局和新生儿出生差异。结果卵裂期D2和D3评级对临床妊娠率、活产率、新生婴儿身高和体重和性别比等差异均无统计学意义(P> 0.05);影响活产率最重要的指标为优质囊胚率。当D3评级为不可用胚胎时,卵裂球N≥6组的临床结局好于卵裂球N <6组,但是并无统计学差异。结论在进行选择性单囊胚复苏周期移植时,优质囊胚是首选。虽然囊胚的卵裂期评级对妊娠结局影响不大,但是最好选择第二天评级为可用胚胎的囊胚。如果D3评级为不可用胚胎时,首先选择D2评级为可用胚胎而且D3卵裂球细胞数较多(N≥6)的囊胚进行移植。
Objective To investigate the relationship between blastocyst development potential and neonatal birth conditions according to the embryo quality at day 2 and day 3.Methods A retrospective analysis of 340cycles of vitrified-warmed single blastocyst transplantation from June 2013 to October 2017 was performed.Blastocysts were classified into good-quality embryo and poor-quality embryo groups according to cleavage stage scores.The influence of day-2 and day-3 embryo morphology on pregnancy outcomes and neonate.s condition were analyzed.Results The D2 and D3 ratings in cleavage stage had no significant differencees in clinical pregnancy rate,live birth rate,height and weight and sex ratio of newborn infants.The most important indicator affecting live birth rate was whether it is a high quality blastocysts.When the D3 rating was not available,the clinical outcome of the number of blastomeres over 6 group was better than the number of blastomere less than 6 group,but with no statistical difference.Conclusion High quality blastocysts are preferred when performing selective single blastocyst vitrified-warmed cycles.Although the cleavage stage rating of blastocysts has little effect on pregnancy outcomes,it is better to choose blastocysts which are rated as available embryos on D2.If the D3 rating is not available,D2 rating of available embryos with a larger number of D3 blastomeres(N≥6)are first selected for transplantation.
Objective To investigate the relationship between blastocyst development potential and neonatal birth conditions according to the embryo quality at day 2 and day 3.Methods A retrospective analysis of 340cycles of vitrified-warmed single blastocyst transplantation from June 2013 to October 2017 was performed.Blastocysts were classified into good-quality embryo and poor-quality embryo groups according to cleavage stage scores.The influence of day-2 and day-3 embryo morphology on pregnancy outcomes and neonate.s condition were analyzed.Results The D2 and D3 ratings in cleavage stage had no significant differencees in clinical pregnancy rate,live birth rate,height and weight and sex ratio of newborn infants.The most important indicator affecting live birth rate was whether it is a high quality blastocysts.When the D3 rating was not available,the clinical outcome of the number of blastomeres over 6 group was better than the number of blastomere less than 6 group,but with no statistical difference.Conclusion High quality blastocysts are preferred when performing selective single blastocyst vitrified-warmed cycles.Although the cleavage stage rating of blastocysts has little effect on pregnancy outcomes,it is better to choose blastocysts which are rated as available embryos on D2.If the D3 rating is not available,D2 rating of available embryos with a larger number of D3 blastomeres(N≥6)are first selected for transplantation.
引文
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[11]URMAN B,ALATAS C,MERCAN R,et al.Blastocyst-stage transfer of poor-quality cleavage-stage embryos results in higher implantation rates[J].Fertil Steril,2001,75(3):514-518.
[12]BOOSTANFAR R,JAIN J K,SLATER C C,et al.Clinical assisted reproduction:The prognostic significance of day 3 embryo cleavage stage on subsequent blastocyst development in a sequential culture system[J].J Assist Reprod Genet,2001,18(10):548-550.
[13]KONG X,YANG S,FEI G,et al.The relationship between cell number,division behavior and developmental potential of cleavage stage human Embryos:A Time-Lapse Study[J].Plos One,2016,11(4):e0153697.
[14]DAL CANTO M,COTICCHIO G,MIGNINI RENZINI M,Cleavage kinetics analysis of human embryos predicts development to blastocyst and implantation[J].Reprod Biomed Online,2012,25(5):474-480.
[2]HERBEMONT C,SARANDI S,BOUJENAH J,et al.Should we consider day-2 and day-3 embryo morphology before day-5transfer when blastocysts reach a similar good quality?[J].Fertil Steril,2016,106(3):e204-e204.
[3]TAKESHIMA K,JWA S C,SAITO H,et al.Impact of single embryo transfer policy on perinatal outcomes in fresh and frozen cycles-analysis of the Japanese Assisted Reproduction Technology registry between 2007 and 2012[J].Fertil Steril,2016,105(2):337-346.e3..
[4]ISHIHARA O,ARAKI R,KUWAHARA A,et al.Impact of frozen-thawed single-blastocyst transfer on maternal and neonatal outcome:an analysis of 277,042 single-embryo transfer cycles from2008 to 2010 in Japan[J].Fertil Steril,2014,101(1):128-133.
[5]WEI D,SUN Y,LIU J,et al.Live birth after fresh versus frozen single blastocyst transfer(Frefro-blastocyst):study protocol for a randomized controlled trial[J].Trials,2017,18(1):253.
[6]孟庆霞,郑爱燕,丁洁,等.囊胚发育速度和质量对复苏周期妊娠结局及新生儿出生情况的影响[J].实用医学杂志,2017,33(21):3585-3589.
[7]任新玲,章汉旺,刘群,等.复苏周期单囊胚移植的影响因素分析[J].华中科技大学学报(医学版),2011,40(6):742-745.
[8]AZZARELLO A,HOEST T,HAYSCHMIDT A,et al.Live birth rate and number of blastomeres on day 2 transfer[J].J Assist Reprod Genet,2016,33(10):1-6.
[9]KROENER L L,AMBARTSUMYAN G,PISARSKA M D,et al.Increased blastomere number in cleavage-stage embryos is associatedwithhigheraneuploidy[J].FertilSteril,2015,103(3):694-698.
[10]ZHAN Q,YE Z,CLARKE R,et al.Direct unequal cleavages:Embryo developmental competence,genetic constitution and clinical outcome[J].PLoS One,2016,11(12):e0166398.
[11]URMAN B,ALATAS C,MERCAN R,et al.Blastocyst-stage transfer of poor-quality cleavage-stage embryos results in higher implantation rates[J].Fertil Steril,2001,75(3):514-518.
[12]BOOSTANFAR R,JAIN J K,SLATER C C,et al.Clinical assisted reproduction:The prognostic significance of day 3 embryo cleavage stage on subsequent blastocyst development in a sequential culture system[J].J Assist Reprod Genet,2001,18(10):548-550.
[13]KONG X,YANG S,FEI G,et al.The relationship between cell number,division behavior and developmental potential of cleavage stage human Embryos:A Time-Lapse Study[J].Plos One,2016,11(4):e0153697.
[14]DAL CANTO M,COTICCHIO G,MIGNINI RENZINI M,Cleavage kinetics analysis of human embryos predicts development to blastocyst and implantation[J].Reprod Biomed Online,2012,25(5):474-480.