Gleicher Norbert, Kushnir Vitaly A, Barad David H
The Center for Human Reproduction, 21 E 69th Street, New York, NY, USA.
Reprod Biol Endocrinol. 2015 Jan 11;13:3. doi: 10.1186/1477-7827-13-3.
Embryo selection has been an integral feature of in vitro fertilization (IVF) almost since its inception. Since the advent of extended blastocyst stage embryo culture, and especially with increasing popularity of elective single embryo transfer (eSET), the concept of embryo selection has increasingly become a mainstay of routine IVF.
We here, however, argue that embryo selection via blastocyst stage embryo transfer (BSET), as currently practiced, at best improves IVF outcomes only for a small minority of patients undergoing IVF cycles. For a large majority BSET is either ineffective or, indeed, may actually be harmful by decreasing IVF pregnancy chances. Overall, only a small minority of patients, thus, benefit from prolonged embryo culture, while BSET, as a tool to enhance IVF outcomes, is increasingly utilized as routine care in IVF for all patients.
Since newer methods of embryo selection, like preimplantation genetic screening (PGS) and closed system embryo incubation with time-lapse photography are practically dependent on BSET, these concepts of embryo selection, currently increasingly adopted in mainstream IVF, require reconsideration. They, automatically, transfer the downsides of BSET, including decreases in IVF pregnancy chances in some patients, to these new procedures, and in addition raise serious questions about cost-effectiveness.
自体外受精（IVF）诞生以来，胚胎选择几乎一直是其不可或缺的特征。自从延长囊胚期胚胎培养出现以来，尤其是随着选择性单胚胎移植（eSET）越来越受欢迎，胚胎选择的概念日益成为常规IVF的支柱。
然而，我们在此认为，目前所采用的通过囊胚期胚胎移植（BSET）进行胚胎选择，充其量仅能改善一小部分接受IVF周期治疗的患者的IVF结局。对于大多数患者而言，BSET要么无效，实际上甚至可能因降低IVF妊娠几率而有害。因此，总体而言，只有一小部分患者能从延长胚胎培养中获益，而BSET作为一种改善IVF结局的工具，却越来越多地被用作所有患者IVF的常规治疗手段。
由于较新的胚胎选择方法，如植入前基因筛查（PGS）和采用延时摄影的封闭系统胚胎培养，实际上都依赖于BSET，目前在主流IVF中越来越多地采用的这些胚胎选择概念需要重新审视。它们会自动将BSET的弊端（包括一些患者IVF妊娠几率降低）转嫁到这些新程序上，此外还引发了关于成本效益的严重问题。
