废弃胚胎继续囊胚培养对IVF/ICSI周期的意义

The significance of extended culturing discarded embryos to blastocysts on IVF/ICSI treatment cycles

目的探讨体外受精/卵胞浆内单精子注射(IVF/ICSI)周期中第3天(D3)废弃胚胎形成囊胚的潜能及与妊娠结局的关系。方法回顾性分析1512个IVF/ICSI周期中进行囊胚培养的10355个废弃胚胎,比较了不同胚胎评分的废弃胚胎囊胚形成情况,还对这些囊胚移植后的临床结局进行了分析。结果废弃胚胎的囊胚形成率为17.45%,优质囊胚率为9.38%。按不同胚胎评分对囊胚形成率和优质囊胚率进行比较,优质胚胎(Ⅰ-Ⅱ级)最高(P<0.05),Ⅲ级胚胎次之,Ⅳ级胚胎最低。Ⅳ级胚胎中,正常受精(2PN)胚胎的囊胚形成率和优质囊胚率均显著高于异常受精的无原核(0PN)和单原核(1PN)(P<0.05)。废弃胚胎来源囊胚移植后可获得妊娠结局。结论 IVF/ICSI周期中的废弃胚胎继续培养后仍具有形成囊胚的潜能和获得妊娠结局的可能。

Objective:To investigate the potential of day 3(D3)discarded embryos to form blastocysts and their relationship with pregnancy outcomes during in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)treatment cycles. Methods:A retrospective analysis of 10355 discarded embryos used for blastocyst culture was performed in 1512 IVF/ICSI cycles. The blastocysts generated from discarded embryos with different score were compared. The clinical outcomes after blastocyst transfer were analyzed. Results:The blastocyst formation rate of discarded embryos was 17.45%,and the high-quality blastocyst rate was 9.38%. The blastocyst formation rate and high-quality blastocyst rate were compared according to different embryo scores,the high-quality embryos(Ⅰ-Ⅱ grade)were the highest(P<0.05),the grade Ⅲ embryos were the second,and the grade Ⅳ embryos were the lowest. In grade Ⅳ embryos,the blastocyst formation rate and high-quality blastocyst rate of normal fertilized(2 PN)embryos were significantly higher than those of abnormal fertilization without pronuclear(0 PN)or with single pronucleus(1 PN)(P<0.05). Pregnancy outcomes can be obtained after transplantation of discarded embryo-derived blastocysts.Conclusion:The continuous culture of discarded embryos in the IVF/ICSI cycle still have the potential to form blastocysts and result in pregnancy outcomes.