结合胚胎实时监测和 array CGH 检测选择合适的囊胚进行移植用于行植入前遗传学筛查患者：一项利用姐妹卵母细胞的前瞻性研究。
Selection of competent blastocysts for transfer by combining time-lapse monitoring and array CGH testing for patients undergoing preimplantation genetic screening: a prospective study with sibling oocytes.
机构信息
ART and REI Division, Pacific Reproductive Center, Torrance, CA, USA.
出版信息
BMC Med Genomics. 2014 Jun 22;7:38. doi: 10.1186/1755-8794-7-38.
BACKGROUND
Recent advances in time-lapse monitoring in IVF treatment have provided new morphokinetic markers for embryonic competence. However, there is still very limited information about the relationship between morphokinetic parameters, chromosomal compositions and implantation potential. Accordingly, this study aimed at investigating the effects of selecting competent blastocysts for transfer by combining time-lapse monitoring and array CGH testing on pregnancy and implantation outcomes for patients undergoing preimplantation genetic screening (PGS).
METHODS
A total of 1163 metaphase II (MII) oocytes were retrieved from 138 PGS patients at a mean age of 36.6 ± 2.4 years. These sibling MII oocytes were then randomized into two groups after ICSI: 1) Group A, oocytes (n = 582) were cultured in the time-lapse system and 2) Group B, oocytes (n = 581) were cultured in the conventional incubator. For both groups, whole genomic amplification and array CGH testing were performed after trophectoderm biopsy on day 5. One to two euploid blastocysts within the most predictive morphokinetic parameters (Group A) or with the best morphological grade available (Group B) were selected for transfer to individual patients on day 6. Ongoing pregnancy and implantation rates were compared between the two groups.
RESULTS
There were significant differences in clinical pregnancy rates between Group A and Group B (71.1% vs. 45.9%, respectively, p = 0.037). The observed implantation rate per embryo transfer significantly increased in Group A compared to Group B (66.2% vs. 42.4%, respectively, p = 0.011). Moreover, a significant increase in ongoing pregnancy rates was also observed in Group A compared to Group B (68.9% vs. 40.5%. respectively, p = 0.019). However, there was no significant difference in miscarriage rate between the time-lapse system and the conventional incubator (3.1% vs. 11.8%, respectively, p = 0.273).
CONCLUSIONS
This is the first prospective investigation using sibling oocytes to evaluate the efficiency of selecting competent blastocysts for transfer by combining time-lapse monitoring and array CGH testing for PGS patients. Our data clearly demonstrate that the combination of these two advanced technologies to select competent blastocysts for transfer results in improved implantation and ongoing pregnancy rates for PGS patients.
背景
体外受精治疗中延时监测的最新进展为胚胎能力提供了新的形态动力学标记。然而，关于形态动力学参数、染色体组成和植入潜能之间的关系，信息仍然非常有限。因此，本研究旨在通过结合延时监测和 array CGH 测试来选择有活力的囊胚进行转移，以调查这对接受植入前遗传学筛查（PGS）的患者的妊娠和种植结局的影响。
方法
从 138 名 PGS 患者中获得 1163 个中期 II 期（MII）卵母细胞，平均年龄为 36.6±2.4 岁。这些姐妹 MII 卵母细胞在 ICSI 后随机分为两组：1）A 组，卵母细胞（n=582）在延时系统中培养；2）B 组，卵母细胞（n=581）在常规培养箱中培养。两组均在第 5 天进行滋养外胚层活检后进行全基因组扩增和 array CGH 测试。在最具预测形态动力学参数的一组（A 组）或具有最佳形态学等级的一组（B 组）中选择一到两个整倍体囊胚进行第 6 天的个体患者转移。比较两组之间的临床妊娠率和种植率。
结果
A 组和 B 组的临床妊娠率存在显著差异（分别为 71.1%和 45.9%，p=0.037）。A 组胚胎移植的观察到的种植率明显高于 B 组（分别为 66.2%和 42.4%，p=0.011）。此外，A 组的持续妊娠率也明显高于 B 组（分别为 68.9%和 40.5%，p=0.019）。然而，延时系统和常规培养箱之间的流产率没有显著差异（分别为 3.1%和 11.8%，p=0.273）。
结论
这是首次使用姐妹卵母细胞进行前瞻性研究，以评估通过结合延时监测和 array CGH 测试选择有活力的囊胚进行转移对 PGS 患者的效率。我们的数据清楚地表明，这两种先进技术的结合选择有活力的囊胚进行转移，可提高 PGS 患者的种植率和持续妊娠率。
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