应用时差成像技术挑选优质胚胎改善单胚胎移植妊娠结局

Selection of high-quality embryos by time-lapse imaging for improving the pregnancy outcome of single embryo transfer

目的:探讨应用时差成像(TLI)技术基于胚胎卵裂模式及时间参数进行胚胎挑选,对分裂期胚胎单胚胎移植(SET)妊娠结局的影响。方法:1将206个常规IVF周期患者胚胎行TLI动态观察,对其2 349枚非移植胚胎进行囊胚培养,回顾性分析胚胎发育的卵裂模式和时间参数,以囊胚质量为结局进行Logistic回归分析,建立优质胚胎筛选标准。2应用建立的优质胚胎筛选标准开展分裂期胚胎SET的前瞻性研究,用TLI观察88例常规IVF周期患者的胚胎发育情况,挑选优质胚胎进行SET,观察妊娠结局。结果:1分裂方式为正常卵裂、不均卵裂、非轴性卵裂的胚胎具有较高的优质囊胚形成率(分别为57.09%,44.44%及40.91%),时间参数从3-细胞分裂到4-细胞持续的时间(s2)(≤0.50 h)和发育至5-细胞的时间(t5)(≤48.93 h)对优质囊胚形成最具预测价值。2由此建立基于胚胎卵裂模式与时间参数的分层筛选模式,将其应用于分裂期胚胎SET,符合筛选条件的SET组临床妊娠率为73.24%(52/71)。结论:应用TLI,基于胚胎卵裂模式和时间参数建立了分层筛选模式,所挑选的优质胚胎可显著改善分裂期胚胎SET的妊娠结局。

Objective： To discuss whether the selection of embryos based on embryo cleavage patterns and time parameters by time-lapse imaging（TLI） can improve the pregnancy outcome of single embryo transfer（SET） in the cleavage stage. Methods： A retrospective analysis on the data of 206 patients with IVF cycles was performed by TLI dynamic observation, of which a total of 2 349 non-transplanted embryos were used for blastocyst culture. A Logistic regression analysis on time parameters and cleavage patterns of embryo development was conducted by taking the blastocyst quality as the outcome and a good-quality embryo screening standard was established. A prospective study on SET was carried out in the cleavage stage by application of this standard. The embryo development of 88 patients with traditional IVF cycle was observed by TLI, the SET was done by selecting high-quality embryos, and the pregnancy outcomes were observed. Results： The Logistic regression analysis showed embryos with normal cleavage, uneven cleavage and non-axial cleavage had a high formation rate of good-quality blastocyst（57.09%, 44.44% and 40.91%, respectively）. S2（≤ 0.50 h） and t5（≤ 48.93 h） were the time parameters with the most predictive value for formation of high-quality blastocysts.A hierarchical screening mode based on embryo cleavage patterns and time parameters was established and was used for SET in the cleavage stage, and the clinical pregnancy rate of SET in line with the screening conditions was 73.24%（52/71）. Conclusion： The hierarchical screening mode established based on the embryo cleavage patterns and time parameters can significantly improve the clinical pregnancy rate of SET in the cleavage stage by selecting high-quality embryos.