Maheshwari Abha, Hamilton Mark, Bhattacharya Siladitya
Aberdeen Fertility Centre, NHS Grampian, Foresterhill, Aberdeen AB25 2ZL, UK.
Aberdeen Fertility Centre, NHS Grampian, Foresterhill, Aberdeen AB25 2ZL, UK.
Reprod Biomed Online. 2016 Feb;32(2):142-6. doi: 10.1016/j.rbmo.2015.09.016. Epub 2015 Oct 22.
Improved laboratory standards and better culture media have made extended culture to blastocyst stage a reality to identify embryos with maximum implantation potential. The strategy of extended culture has become more popular across the world at a time when regulatory bodies have emphasized the need to increase the uptake of elective single embryo transfer, minimize complications associated with multiple births and aim for a healthy singleton live-birth as the preferred outcome in IVF. New data on perinatal outcomes suggest that pregnancies after embryo transfer at blastocyst stage are associated with a higher risk of preterm delivery, large for gestational age babies, monozygotic twins and altered sex ratio compared with those following embryo transfers at cleavage stage. In addition, concerns have been raised of increased congenital anomalies and epigenetic modifications with embryo transfer at blastocyst stage. Twenty-four years on from the first embryo transfer at blastocyst stage, we examine the reasons for extended embryo culture, evaluate the risks and benefits of this strategy and suggest the need to reconsider this policy in the interests of fetal safety.
改进的实验室标准和更好的培养基使胚胎培养至囊胚阶段成为现实，从而能够识别具有最大着床潜力的胚胎。在监管机构强调需要增加选择性单胚胎移植的采用率、尽量减少与多胎妊娠相关的并发症，并将健康的单胎活产作为体外受精的首选结果之际，延长培养策略在全球范围内变得更加流行。围产期结局的新数据表明，与卵裂期胚胎移植相比，囊胚期胚胎移植后的妊娠与早产、大于胎龄儿、单卵双胎和性别比例改变的风险更高有关。此外，有人担心囊胚期胚胎移植会增加先天性异常和表观遗传修饰。自首次进行囊胚期胚胎移植24年以来，我们研究了延长胚胎培养的原因，评估了该策略的风险和益处，并建议为了胎儿安全需要重新考虑这一政策。
