Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden.
Department of Obstetrics and Gynaecology, Institute of Clinical Sciences, Sahlgrenska Academy, Reproductive Medicine, Sahlgrenska University Hospital, SE-413 45 Gothenburg, Sweden
Hum Reprod. 2015 Feb;30(2):268-75. doi: 10.1093/humrep/deu316. Epub 2014 Nov 28.
STUDY QUESTION: Does culture in a closed system result in an increased number of good quality embryos (GQE) on Day 2 compared with culture in a conventional system? SUMMARY ANSWER: Culture in a closed system up to 2 days after microinjection results in similar embryo development and morphological quality compared with culture in a conventional incubation system. WHAT IS KNOWN ALREADY: Time-lapse imaging (TLI) incubators are rapidly being introduced into IVF laboratories worldwide, despite the lack of large prospective randomized trials demonstrating improvement in embryo development or pregnancy rates. STUDY DESIGN, SIZE, DURATION: A randomized controlled trial including 364 patients (365 cycles) was conducted between May 2010 and February 2014. After oocyte collection, randomization was carried out and all of a patients' oocytes were allocated to culture in either a conventional incubator or a closed incubator system in proportion 1:2 until embryo transfer on Day 2. A total of 1979 oocytes were injected and cultured in the closed system, and 1000 in the standard incubator. The primary end-point was the number of GQE in the two groups. PARTICIPANTS/MATERIALS, SETTINGS, METHODS: In total, 364 patients undergoing their first IVF cycle using ICSI, where at least one oocyte was retrieved, were randomized in a university hospital setting. Two hundred and forty patients were randomized for culture in a closed system and 124 patients for culture in the conventional incubator system (control group). Embryo assessments and final morphological scoring before transfer and cryopreservation were carried out at the same time points for embryos cultured in the conventional incubator and in the closed system. MAIN RESULTS AND THE ROLE OF CHANCE: There was no significant difference in the mean ± SD number of GQEs between groups: 2.41 ± 2.27 for the closed system group and 2.19 ± 1.82 for the control group (P = 0.34, difference 0.23, 95% confidence interval 0.69; -0.24). No significant differences were found in the number of 4-cell embryos, implantation-, pregnancy- or ongoing pregnancy rates. A significantly higher miscarriage rate was found in the TLI group compared with the control group (33.3 and 10.2%, P = 0.01). LIMITATIONS, REASONS FOR CAUTION: Culture media, temperature and gas levels were similar in the open and closed incubator systems, but different culture dishes were used. Culturing embryos for longer time period (to the blastocyst stage) may give different results. Only ICSI patients were included, which may limit the generalizability of the results. Finally, the number of GQEs on Day 2 was used as a surrogate outcome for live birth. WIDER IMPLICATIONS OF THE FINDINGS: The results are consistent with other, smaller randomized trials showing no difference in embryo quality when comparing culture in a conventional incubator with that of a closed TLI incubator system.
研究问题:与传统培养系统相比,在封闭系统中培养是否会导致第 2 天的优质胚胎(GQE)数量增加?
总结答案:与传统孵育系统相比,微注射后 2 天内的封闭系统培养导致胚胎发育和形态质量相似。
已知情况:尽管缺乏大型前瞻性随机试验证明胚胎发育或妊娠率的改善,但时间延迟成像(TLI)培养箱正在全球范围内迅速引入 IVF 实验室。
研究设计、大小、持续时间:这是一项包括 364 名患者(365 个周期)的随机对照试验,于 2010 年 5 月至 2014 年 2 月进行。在卵母细胞采集后,进行随机分组,患者的所有卵母细胞按 1:2 的比例分配到传统培养箱或封闭培养箱系统中培养,直到第 2 天进行胚胎移植。共有 1979 个卵母细胞在封闭系统中进行了注射和培养,1000 个在标准培养箱中进行了培养。主要终点是两组的 GQE 数量。
参与者/材料、设置、方法:在一家大学医院环境中,共有 364 名接受首次使用 ICSI 的患者接受了随机分组,这些患者至少有一个卵母细胞被取出。240 名患者被随机分配到封闭系统中培养,124 名患者被分配到传统培养箱系统(对照组)中培养。在传统培养箱和封闭系统中培养的胚胎在相同的时间点进行胚胎评估和最终形态评分,然后进行转移和冷冻保存。
主要结果和机会的作用:两组的 GQE 平均值差异无统计学意义:封闭系统组为 2.41±2.27,对照组为 2.19±1.82(P=0.34,差异 0.23,95%置信区间 0.69;-0.24)。4 细胞胚胎数量、着床率、妊娠率或持续妊娠率无显著差异。与对照组相比,TLI 组的流产率显著升高(33.3%和 10.2%,P=0.01)。
局限性、谨慎的原因:开放和封闭培养箱系统中的培养介质、温度和气体水平相似,但使用了不同的培养皿。培养胚胎的时间更长(到囊胚阶段)可能会产生不同的结果。仅纳入了接受 ICSI 的患者,这可能限制了结果的普遍性。最后,第 2 天的 GQE 数量被用作活产的替代结果。
研究结果的更广泛意义:这些结果与其他较小的随机试验一致,表明在比较传统培养箱和封闭的 TLI 培养箱系统时,胚胎质量没有差异。
Hum Reprod. 2013-6-11
Reprod Biol Endocrinol. 2017-5-8
J Assist Reprod Genet. 2023-1
Ther Adv Reprod Health. 2020-12-7
Hum Reprod Open. 2020-3-19
Cochrane Database Syst Rev. 2019-5-29
Cochrane Database Syst Rev. 2018-5-25