优质囊胚形成相关因素分析
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摘要
目的探讨授精第3d(D3)卵裂期胚胎继续培养发育成囊胚的情况并分析其影响因素。方法回顾性分析本中心2014年1月到2018年11月D3胚胎移植/冷冻后剩余的81108枚继续囊胚培养的卵裂期胚胎形成囊胚的情况。分别按照女方年龄、D2卵裂球数、D3卵裂球数、胚胎碎片率、空泡、对称性和多核进行分组分析优质囊胚形成与其关系。结果年龄20-22岁组优质囊胚形成率为33.0%,23-32岁组为35.6%,33岁以上为28.0%,3组间比较差异均有计学差异(P<0.0001)。D2卵裂球数<4个组优质囊胚形成率为20.4%,等于4个组(40.6%),大于4个组(27.7%),3组间有统计学差异(P<0.001)。D3卵裂球数≤6组优质囊胚形成率18.7%,7-10个组35%,≥11个组53.3%,3组间比较均有统计学差异(P<0.001)。碎片率≤20%组优质囊胚形成率显著高于碎片率>20%组(33.9%vs 28.3%,P<0.001)。D3卵裂球对称组优质囊胚形成率明显高于不对称组(36.63%vs 31.73%,P<0.001)。D3胚胎有空泡组优质囊胚形成率明显低于无空泡组(30.23&vs 33.6%,P=0.0188)。D3胚胎有多核组优质囊胚形成率明显低于无多核组(22.66%vs 33.63%,P<0.001)。Logistic分析发现女方年两、碎片、空泡、对称性及多核均为优质囊胚形成的独立影响因素。结论优质囊胚形成与女方年龄、卵裂球数、胚胎碎片率、空泡、对称性及多核均相关,患者进行囊胚培养进行单囊胚移植时需要综合考虑多方因素,从而可以通过囊胚培养筛选出具有发育潜能的囊胚移植或冷冻,提高病人IVF周期移植胚胎数目,提高妊娠率及提高可利用胚胎的可行方法。
Objective Investigate the continuous culture and development of blastocyst from embryo at the third day(D3)cleavage after fertilization and analyze the influencing factors. Methods A retrospective analysis was conducted on the formation of blastocysts from 81108 blastocysts remaining after D3 embryo transfer/freezing from January 2014 to November 2018. The relationships between high quality blastocyst formation and blastocyst formation were analyzed by age of female, number of D2 blastocyst, number of D3 blastocyst, embryo fragmentation rate, vacuoles, symmetry and multiple nuclei. Results The rate of high quality blastocyst formation was 33.0% in the group aged 20-22 years, 35.6% in the group aged 23-32 years, and 28.0% in the group aged 33 years and above.The rate of high-quality blastocyst formation was 20.4% in D2 blastocyst number < 4 groups, equal to 4 groups(40.6%), greater than 4 groups(27.7%), and there was a statistical difference between the three groups(P<0.001). The formation rate of high-quality blastocyst was 18.7% in the D3 group with the number of cleavage spheres less than 6, 35% in the 7～10 groups, and 53.3% in the 11 groups with the number of cleavage spheres greater than or equal to 6(P <0.001). The rate of high-quality blastocyst formation was 33.9% in the group with fragment rate of 20%, which was significantly higher than that in the group with fragment rate of > 20%(28.3%, P<0.001). The rate of high quality blastocyst formation in the D3 blastocyst symmetry group was 36.63%, significantly higher than that in the asymmetric group(31.73%, P<0.001). The rate of high-quality blastocyst formation in the D3 embryo vacuolation group was 30.23%, significantly lower than that in the non-vacuolation group(33.6%, P=0.0188). The rate of high quality blastocyst formation in the D3 embryo multicore group was 22.66%, significantly lower than that in the non-multicore group(33.63%, P<0.001). Logistic analysis showed that two years, debris, vacuoles, symmetry and multiple nuclei were independent factors affecting the formation of high-quality blastocyst. Conclusion High-quality blastocyst formation and the woman's age, number of cleavage ball, pieces of embryo rate, cavitation, symmetry, and multi-core are related,to single blastocyst transplant patients for blastocyst culture need to consider many factors, in order to develop screened by blastocyst has the development potential of the blastocyst transplant or frozen, number of embryo transfer, improving patient IVF cycle,improve the pregnancy rate and available embryos.
Objective Investigate the continuous culture and development of blastocyst from embryo at the third day(D3)cleavage after fertilization and analyze the influencing factors. Methods A retrospective analysis was conducted on the formation of blastocysts from 81108 blastocysts remaining after D3 embryo transfer/freezing from January 2014 to November 2018. The relationships between high quality blastocyst formation and blastocyst formation were analyzed by age of female, number of D2 blastocyst, number of D3 blastocyst, embryo fragmentation rate, vacuoles, symmetry and multiple nuclei. Results The rate of high quality blastocyst formation was 33.0% in the group aged 20-22 years, 35.6% in the group aged 23-32 years, and 28.0% in the group aged 33 years and above.The rate of high-quality blastocyst formation was 20.4% in D2 blastocyst number < 4 groups, equal to 4 groups(40.6%), greater than 4 groups(27.7%), and there was a statistical difference between the three groups(P<0.001). The formation rate of high-quality blastocyst was 18.7% in the D3 group with the number of cleavage spheres less than 6, 35% in the 7～10 groups, and 53.3% in the 11 groups with the number of cleavage spheres greater than or equal to 6(P <0.001). The rate of high-quality blastocyst formation was 33.9% in the group with fragment rate of 20%, which was significantly higher than that in the group with fragment rate of > 20%(28.3%, P<0.001). The rate of high quality blastocyst formation in the D3 blastocyst symmetry group was 36.63%, significantly higher than that in the asymmetric group(31.73%, P<0.001). The rate of high-quality blastocyst formation in the D3 embryo vacuolation group was 30.23%, significantly lower than that in the non-vacuolation group(33.6%, P=0.0188). The rate of high quality blastocyst formation in the D3 embryo multicore group was 22.66%, significantly lower than that in the non-multicore group(33.63%, P<0.001). Logistic analysis showed that two years, debris, vacuoles, symmetry and multiple nuclei were independent factors affecting the formation of high-quality blastocyst. Conclusion High-quality blastocyst formation and the woman's age, number of cleavage ball, pieces of embryo rate, cavitation, symmetry, and multi-core are related,to single blastocyst transplant patients for blastocyst culture need to consider many factors, in order to develop screened by blastocyst has the development potential of the blastocyst transplant or frozen, number of embryo transfer, improving patient IVF cycle,improve the pregnancy rate and available embryos.
引文
[1]Blastocyst culture and transfer in clinically assisted reproduction:a committee opinion[J].Fertil Steril,2018,110(7):1246-1252.
[2]Hammond E R,Cree L M,Morbeck D E.Should extended blastocyst culture include Day 7?[J].Hum Reprod,2018,33(6):991-997.
[3]Tannus S,Son W Y,Dahan M H.Elective single blastocyst transfer in advanced maternal age[J].J Assist Reprod Genet,2017,34(6):741-748.
[4]Sullivan E A,Wang Y A,Hayward I,et al.Single embryo transfer reduces the risk of perinatal mortality,a population study[J].Hum Reprod,2012,27(12):3609-3615.
[5]Adashi E Y,Gleicher N.Is a Blanket Elective Single Embryo Transfer Policy Defensible?[J].Rambam Maimonides Med J,2017,8(2).
[6]Blastocyst culture and transfer in clinically assisted reproduction:a committee opinion[J].Fertil Steril,2018,110(7):1246-1252.
[7]Wang R,Zheng Q,Wang F,et al.The significance of blastocyst culture for discarded embryos in the treatment period of in-vitro fertilization and embryo transfer without available embryos[J].Minerva Med,2017,108(6):595-597.
[8]Ubaldi F M,Cimadomo D,Vaiarelli A,et al.Advanced Maternal Age in IVF:Still a Challenge?The Present and the Future of Its Treatment[J].Front Endocrinol(Lausanne),2019,10:94.
[9]Thum M Y,Wells V,Abdalla H.Patient selection criteria for blastocyst culture in IVF/ICSI treatment[J].J Assist Reprod Genet,2010,27(9-10):555-560.
[10]Kroener L L,Ambartsumyan G,Pisarska M D,et al.Increased blastomere number in cleavage-stage embryos is associated with higher aneuploidy[J].Fertil Steril,2015,103(3):694-698.
[11]Eftekhari-Yazdi P,Valojerdi M R,Ashtiani S K,et al.Effect of fragment removal on blastocyst formation and quality of human embryos[J].Reprod Biomed Online,2006,13(6):823-832.
[2]Hammond E R,Cree L M,Morbeck D E.Should extended blastocyst culture include Day 7?[J].Hum Reprod,2018,33(6):991-997.
[3]Tannus S,Son W Y,Dahan M H.Elective single blastocyst transfer in advanced maternal age[J].J Assist Reprod Genet,2017,34(6):741-748.
[4]Sullivan E A,Wang Y A,Hayward I,et al.Single embryo transfer reduces the risk of perinatal mortality,a population study[J].Hum Reprod,2012,27(12):3609-3615.
[5]Adashi E Y,Gleicher N.Is a Blanket Elective Single Embryo Transfer Policy Defensible?[J].Rambam Maimonides Med J,2017,8(2).
[6]Blastocyst culture and transfer in clinically assisted reproduction:a committee opinion[J].Fertil Steril,2018,110(7):1246-1252.
[7]Wang R,Zheng Q,Wang F,et al.The significance of blastocyst culture for discarded embryos in the treatment period of in-vitro fertilization and embryo transfer without available embryos[J].Minerva Med,2017,108(6):595-597.
[8]Ubaldi F M,Cimadomo D,Vaiarelli A,et al.Advanced Maternal Age in IVF:Still a Challenge?The Present and the Future of Its Treatment[J].Front Endocrinol(Lausanne),2019,10:94.
[9]Thum M Y,Wells V,Abdalla H.Patient selection criteria for blastocyst culture in IVF/ICSI treatment[J].J Assist Reprod Genet,2010,27(9-10):555-560.
[10]Kroener L L,Ambartsumyan G,Pisarska M D,et al.Increased blastomere number in cleavage-stage embryos is associated with higher aneuploidy[J].Fertil Steril,2015,103(3):694-698.
[11]Eftekhari-Yazdi P,Valojerdi M R,Ashtiani S K,et al.Effect of fragment removal on blastocyst formation and quality of human embryos[J].Reprod Biomed Online,2006,13(6):823-832.