D2和D3胚胎形态学参数与植入率相关性分析

Correlation of D2 and D3 embryo morphology parameters and embryo implantation rate

目的探讨成功植入胚胎的形态学参数,为胚胎移植的选择提供数据支持。方法回顾性分析2010年4月-2015年10月于我院生殖医学中心行体外受精（in vitro fertilization,IVF）或单精子卵胞浆注射（intracytoplasmic sperm injection,ICSI）-胚胎移植（embryo transfer,ET）助孕新鲜移植的113个周期,根据植入率分为胚胎100%植入组与0植入组,比较两组胚胎受精第2天（D2）和受精第3天（D3）卵裂球数目、碎片程度、细胞核状态及卵裂球对称程度的差异。结果两组女方年龄、原发不孕比例、不孕因素、基础卵泡刺激素（follicle stimulating hormone,FSH）水平、窦卵泡数（antral follicle count,AFC）、人绒毛膜促性腺激素（human chorionic gonadotrophin,h CG）注射日雌激素（estradiol,E_2）水平、促性腺激素（gonadotropin,Gn）用量、受精方式差异无统计学意义（P〉0.05）。100%植入组中D2卵裂球数为4细胞的胚胎比例显著高于0植入组（84.82%vs50.82%,P=0.000）;胚胎碎片程度为10%-25%的比例有统计学差异（4.46%vs 12.30%,P=0.032）;细胞核方面,每个卵裂球细胞可见1个清晰的细胞核和未见细胞核比例的差异有统计学意义（17.86%vs 8.20%,P=0.027;74.11%vs 85.25%,P=0.034）;卵裂球对称程度两组间无差异。100%植入组D3的卵裂球数为8细胞的胚胎比例显著高于0植入组（66.96%vs 45.08%,P=0.001）,而≤7细胞的胚胎比例则显著低于0植入组（15.18%vs 34.43%,P=0.001）;胚胎碎片程度、细胞核状态、卵裂球对称程度无统计学差异。结论建议综合患者临床情况,优先选择D2为4细胞、D3为8细胞并且碎片较少的胚胎进行移植。

Objective To investigate the morphological parameters of successfully implanted human embryo and provide evidence for the selection of embryo implantation. Methods A retrospective study of fresh embryo transfers in 113 IVF/ICSI-ET cycles from April 2010 to October 2015 was undertaken in Chinese PLA General Hospital, and according to the implantation rate, the cycles were divided into two groups： 100% implantation group and 0 implantation group. The variables including blastomere number, degree of fragmentation, proportion of mononucleated blastomeres and symmetry of cleavage were observed and the differences of these variables between two groups at day 2（D2） and day 3（D3） after being fertilized were compared. Results No significant differences were found between two groups in patients＇ maternal age, the rate of primary infertility, factor of infertility, basal follicle stimulating hormone（FSH）, antral follicle count（AFC）, estradiol on h CG day, total dosage of gonadotrophins administration and methods of assisted insemination（P〉0.05）. While, the proportion of 4-cell embryos on D2 in 100% implantation group was significantly higher than 0 implantation group（84.82% vs50.82%, P=0.000）, and there was significant difference in proportion of 10%- 25% fragmentation（4.46% vs 12.30%, P=0.032）, and the proportion of mononucleated blastomeres and embryos without visible nuclei in all blastomeres between the two groups（17.86% vs 8.20%, P=0.027; 74.11% vs 85.25%, P=0.034）. On D3, the proportion of 8-cell embryos in 100% implantation group was significantly higher than 0 implantation group（66.96% vs 45.08%, P=0.001）. In contrast, the proportion of ≤7-cell embryos in 100% implantation group was significantly lower than 0 implantation group（15.18% vs 34.43%, P=0.001）. But there was no difference in the degree of fragmentation, the proportion of mononucleated blastomeres and symmetry of cleavage on D3 embryos between the two groups. Conclusion Based on the clinical conditions of patients, 4-cell embryo of D2 as well as 8-cell embryo of D3 with less fragments is suggested to be transplanted.