早期异常卵裂对胚胎发育潜能及妊娠结局的影响

Effects of Early Abnormal Cleavage on the Developmental Potential of Embryos and Pregnancy Outcome

目的通过时差成像(time-lapse imaging,TLI)培养系统动态观察胚胎早期发育过程,研究不同卵裂模式对胚胎发育潜能及妊娠结局的影响。方法回顾性分析作者医院2022-03~11月行TLI技术培养的体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)患者112例。通过TLI系统软件分析正常受精后卵裂的1080枚胚胎早期发育的形态学变化。记录各种卵裂模式、统计其发生率,并将其分为正常卵裂组、直接卵裂(direct cleavage,DC)组、胞质异常波动(abnormal fluctuation,AF)组、逆向卵裂(reverse cleavage,RC)组、无序卵裂(chaotic cleavage,CC)组及混合异常卵裂组。比较正常组与异常卵裂组的各项胚胎发育指标及妊娠结局。结果胚胎卵裂模式构成比为:正常卵裂58.61%(633/1080),DC 15.37%(166/1080),AF 4.72%(51/1080),RC 3.52%(38/1080),CC 3.61%(39/1080),混合异常卵裂14.17%(153/1080)。异常卵裂组D3优质胚胎率与正常卵裂组比较差异无统计学意义(P>0.05)(CC组无优质胚胎形成),但其囊胚形成率均低于正常卵裂组(P<0.05);异常卵裂模式中,AF组囊胚形成率最高(61.54%),DC组与AF组可利用囊胚率(80.33%,75.00%)及优质囊胚率(45.90%,45.83%)均较高,与正常卵裂组比较差异无统计学意义(P>0.05)。移植D3单优质胚胎,异常卵裂组(AF组除外)临床妊娠率均显著低于正常卵裂组(P均<0.05),移植单优质囊胚,DC组、AF组的临床妊娠率与正常卵裂组比较,差异无统计学意义(P>0.05)。结论利用TLI技术观察胚胎早期发育的动态表型,结合其他动力学参数,有助于预测胚胎发育潜能,为挑选最优胚胎移植提供准确参考;早期异常卵裂胚胎可行囊胚培养后利用,提高其临床应用价值.

Objective To observe the early embryonic development process by the time-lapse imaging(TLI)culture system,and to study the effects of different cleavage modes on the developmental potential of embryos and pregnancy outcomes.Methods A retrospective analysis was performed on 112 patients with in vitro fertilization and embryo transfer(IVF-ET)cultured by TLI in author′s hospital from March to November 2022.The morphological changes in the early development of 1080 embryos cleaved after normal fertilization were analyzed by TLI system software.Various cleavage patterns were recorded and its incidence was calculated,and the cleavage group was divided into normal cleavage group,direct cleavage(DC)group,abnormal fluctuation(AF)group,reverse cleavage(RC)group,chaotic cleavage(CC)group and mixed abnormal cleavage group.The embryonic development indexes and pregnancy outcomes of normal and abnormal cleavage groups were compared.Results The proportions of embryo cleavage patterns were as follows:the normal cleavage was 58.61%(633/1080),DC was 15.37%(166/1080),AF was 4.72%(51/1080),RC was 3.52%(38/1080),CC was 3.61%(39/1080)and the mixed abnormal cleavage was 14.17%(153/1080).There was no significant difference in the rate of the D3-high-quality embryos between the abnormal cleavage groups and the normal cleavage group(P<0.05)(no high-quality embryos were formed in the CC group),the blastocyst formation rate was lower than that in normal cleavage group(P<0.05);in the abnormal cleavage mode,the blastocyst formation rate in AF group was the highest(61.54%),the available blastocyst rate(80.33%,75.00%)and the good blastocyst rate(45.90%,45.83%)in DC and AF groups respectively were high,and the difference was not statistically significant compared with the normal cleavage group(P<0.05).The clinical pregnancy rate of the abnormal cleavage group(except AF group)was significantly lower than that of the normal cleavage group after transplantation of D3-single-high-quality embryos(all P<0.05),there was no significant difference in the clinical pregnancy rate between the DC,AF groups and the normal cleaved group after transfection of single good blastocyst(P<0.05).Conclusion Using TLI technology to observe the dynamic phenotype of early embryo development and combining other dynamic parameters are helpful in predicting the potential of embryonic development,which providing references for selecting the optimal embryo to transfer;early abnormal cleavage embryos can be used after blastocyst culture to improve the clinical value.