时差成像系统对IVF/ICSI周期胚胎发育及移植结局的影响

Effect of time-lapse imaging system on embryo development and outcome of fresh embryo transfer in IVF/ICSI cycle

目的比较时差成像(TLI)系统培养与常规培养胚胎的发育情况及其新鲜胚胎移植的临床结局,探讨TLI系统应用于辅助生殖技术的临床价值。方法回顾性分析2019年1月至2020年12月在我中心行体外受精(IVF)或卵胞浆内单精子注射(ICSI)并选择新鲜移植的510个周期的临床资料。按照胚胎培养方式的不同分为TLI组(n=166)和常规组(n=344);常规组通过胚胎形态学评分优选胚胎进行移植,TLI组通过胚胎发育动力学参数及形态学评分优选胚胎进行移植。比较两组的一般资料、胚胎发育情况以及卵裂期胚胎新鲜周期移植的临床妊娠结局。结果(1)两组患者的一般资料比较,TLI组的平均年龄显著小于常规组,获卵数显著高于常规组(P<0.05);其余体质量指数(BMI)、基础FSH等指标均无显著性差异(P>0.05)。两组间受精率、2PN卵裂率、D3可利用胚胎率、卵母细胞利用率、D3优质胚胎率均无显著性差异(P>0.05);TLI组的正常受精率(67.99%vs.62.11%)、囊胚形成率(69.51%vs.65.76%)、可利用囊胚率(43.41%vs.38.86%)及优质囊胚率(28.36%vs.24.36%)均显著高于常规组(P<0.05)。TLI组新鲜周期移植胚胎数显著少于常规组(P<0.05);TLI组临床妊娠率较常规组有升高趋势,双胎妊娠率有下降趋势,但尚无显著性差异(P>0.05)。(2)因两组间年龄、获卵数存在统计学差异,故对数据进行倾向性匹配分析。匹配后两组患者间基线资料比较均无显著性差异(P>0.05);相关结局与匹配前基本一致,TLI组的正常受精率、囊胚形成率、可利用囊胚率、优质囊胚率均显著优于常规组(P<0.05),移植胚胎数显著低于常规组(P<0.05),而两组间胚胎种植率、临床妊娠率、流产率均无显著性差异(P>0.05)。结论TLI系统可显著提高卵子的正常受精率,改善囊胚形成和发育,提高囊胚利用率和优质囊胚率,为优选胚胎选择提供了可靠的依据;通过TLI系统选择胚胎,在减少胚胎移植数量的基础上,保证了稳定的临床妊娠结局。因此,认为通过TLI系统可优选出发育潜能较好的胚胎,为单胚胎移植提供有力支持。

Objective:To compare the embryos development under time-lapse imaging(TLI) system and conventional culture system, and the clinical outcome of fresh embryo transfer, and to explore the clinical value of TLI system in assisted reproductive technology.Methods:The data of 510 IVF/ICSI cycles conducted in our center from January 2019 to December 2020 were analyzed retrospectively. According to the different ways of embryo culture, the cycles were divided into two groups: conventional group(n=344) and TLI group(n=166). The embryos were selected for transplantation by embryo morphological score in the conventional group, and those were by embryo developmental kinetic parameters and morphological score in the TLI group. The general data, embryo development and the clinical pregnancy outcome of fresh embryo transfer at cleavage stage were compared between the two groups.Results:Compared with the general data of the two groups, the average age of the TLI group was significantly lower than that of the conventional group, and the number of oocytes retrieved was significantly more than that of the conventional group(P<0.05),and other body mass index(BMI) and basic FSH had no significant difference(P>0.05). There were no significant differences in fertilization rate, 2 PN cleavage rate, Day 3 available embryo rate, oocyte utilization rate and Day 3 high-quality embryo rate between the two groups(P>0.05). However, the normal fertilization rate(67.99% vs. 62.11%),blastocyst formation rate(69.51% vs. 65.76%),available blastocyst rate(43.41% vs. 38.86%),and high-quality blastocyst rate(28.36% vs. 24.36%) in the TLI group were significantly higher than those in the conventional group(P<0.05). The number of fresh embryos transferred in the TLI group was significantly less than that in the conventional group(P<0.05). The clinical pregnancy rate in TLI group was higher than that in conventional group, and the twin pregnancy rate was lower, but there was no significant difference(P>0.05). Because there were statistical differences in age and number of oocytes retrieved between the two groups, the data were analyzed by propensity matching. There was no significant difference in baseline data between the two groups after matching(P>0.05). The related outcomes were basically the same as those before match, and the normal fertilization rate, blastocyst formation rate, available blastocyst rate and high-quality blastocyst rate in TLI group were significantly better than those in conventional group(P<0.05). The number of embryos transferred was significantly less than that of the conventional group(P<0.05),but there were no significant differences in embryo implantation rate, clinical pregnancy rate and abortion rate between the two groups(P>0.05).Conclusions:TLI system can significantly improve the normal fertilization rate, blastocyst formation rate, blastocyst utilization rate and high-quality blastocyst rate, which provides a reliable basis for selecting high-quality embryos. Selecting embryos through TLI system can ensure a stable clinical pregnancy outcome on the basis of reducing the number of embryo transfer. Therefore, it is considered that the embryos with better developmental potential can be selected by TLI system, which can provide strong support for single embryo transfer.