延时摄像技术的胚胎动力学参数与妊娠结局的关系

Embryodynamic Parameters and Pregnancy Outcomes Using Time-Lapse System

目的:探讨延时摄像技术下胚胎动力学参数与妊娠结局的关系,建立一种优胚选择的模型。方法:回顾性分析2016年12月—2017年12月于苏北人民医院生殖中心接受体外受精/胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)的137个延时摄像系统培养周期。收集患者的基本信息、妊娠结局、动力学参数等临床资料,对延时系统组中着床与未着床胚胎的形态动力学参数(t2、t3、t4、t5、t6、t7、t8、cc2、s2、cc3、s3)进行统计分析,找出与胚胎着床潜能相关的参数,建立多变量分级预测模型,并进行验证。结果:①延时系统组有171枚胚胎存在早期异常分裂事件,其中16枚被认为是可移植胚胎并进行了移植,4枚着床。②着床与未着床胚胎之间上述11个时间参数差异均无统计学意义(P>0.05)。③运用Logistic回归分析发现t6(OR=1.462,95%CI:1.093～1.954,P=0.010)、t7(OR=0.803,95%CI:0.653～0.989,P=0.039)为胚胎着床最佳预测因子,结合异常卵裂事件这一排除标准,建立胚胎着床分级预测模型,通过验证,胚胎着床率随着胚胎等级的下降而降低,受试者工作特征(ROC)曲线下面积(AUC)为0.649(95%CI:0.528～0.770)。结论:时间参数t6、t7与胚胎着床潜能密切相关,与异常卵裂排除标准相结合可初步建立一种选胚模型,但仍需进一步验证研究。

Objective:To explore the relationship between the embryodynamic parameters using time-lapse system and the pregnancy outcomes, so as to establish a model of the optimal embryo selection. Methods: A total of 137 cycles with the time-lapse system (IVF/ICSI-ET cycle) were retrospectively analyzed from December 2016 to December 2017. The clinical data including basic information and pregnancy outcomes were collected. The morphokinetic parameters using the time-lapse system (t2、t3、t4、t5、t6、t7、t8、cc2、s2、cc3、s3) were compared between the implanted embryos and the unimplanted embryos. Based on those parameters related with embryo implantation, a multivariate classification model was developed. This model was then primarily verified. Results:①Totally 171 embryos had one or more early abnormal division event,in which 16 were considered to be implantable, and then transplanted. There were 4 embryos implantated succesfully.②There were no significant differences in all of 11 morphokinetic parameters between the implanted embryos and the unimplanted embryos (P>0.05).③The t6 (OR=1.462, 95%CI: 1.093-1.954, P=0.010) and t7 (OR=0.803, 95%CI: 0.653-0.989, P=0.039) could be the best predictors of implantation. A classification model was developed with these two parameters combined with the exclusion standard of abnormal division event. The implantation rate was declined as the embryonic grade dropped. The area under the receiver operating characteristic curve (AUC) was 0.649 (95%CI: 0.528-0.770). Conclusions: Two of morphokinetic parameters (t6, t7) could be closely related to the implantation potential. We tried to develop an embryo selecting model with these two parameters combined with exclusion standard of abnormal division events. It is true that this model should be furtherly validated in our centers.