Devaux A, Lévy R
Département d'histologie, CHU Saint-Antoine, faculté de médecine Pierre-et-Marie-Curie, université Paris-VI, 27, rue de Chaligny, 75012 Paris, France.
Gynecol Obstet Fertil. 2006 Sep;34(9):781-5. doi: 10.1016/j.gyobfe.2006.07.007. Epub 2006 Aug 28.
In spite of recent improvements in IVF, pregnancy rates remained dramatically low. Better criteria are therefore necessary to establish the viability of a transferable top quality embryo. Observation of both pronuclei patterns at the zygote stage and early cleavage appears to offer an additional prognostic tool, correlating with chromosomal status and IVF outcome. Developmental ability and morphological evaluation of the embryo on days 2-3 remains the most used and valid method of selection, even though it is not sufficient to select embryos with the higher implantation potential. Blastocyst culture is another possible strategy for selecting the ideal embryo with theoretical, reduced risk of aneuploidies, though not all major chromosomal aberrations are excluded by prolonged in-vitro-culture. Concerning micro-manipulation of embryo such as hatching or cleaning or cytoplasm transfer, only controversial data are still available. In the field of ART, recent meta-analysis could not conclude to a positive effect concerning hatching, blastocyst culture or systematic PGD-AS (preimplantation genetic diagnosis with aneuploidy screening). Beside the technological aspect, Quality Management System is of great importance. Staff development and monitoring of staff performance in the IVF laboratory has to be considered in the next future.
尽管体外受精（IVF）技术近来有所改进，但妊娠率仍然极低。因此，需要更好的标准来确定可移植的优质胚胎的活力。观察合子期的原核模式和早期卵裂似乎提供了一种额外的预后工具，与染色体状态和IVF结果相关。胚胎在第2 - 3天的发育能力和形态学评估仍然是最常用且有效的选择方法，尽管它不足以选择具有更高着床潜力的胚胎。囊胚培养是另一种选择理想胚胎的可能策略，理论上可降低非整倍体风险，不过延长体外培养并不能排除所有主要的染色体畸变。关于胚胎的显微操作，如孵化、清洗或细胞质移植，目前仍只有存在争议的数据。在辅助生殖技术（ART）领域，最近的荟萃分析未能得出关于孵化、囊胚培养或系统性植入前非整倍体筛查（PGD - AS）有积极效果的结论。除了技术方面，质量管理体系也非常重要。在不久的将来，必须考虑IVF实验室工作人员的发展和对其工作表现的监测。
