Dartmouth-Hitchcock Medical Center, Lebanon, NH, United States.
Adv Clin Chem. 2016;76:55-95. doi: 10.1016/bs.acc.2016.05.001. Epub 2016 Jun 16.
Treatment for many infertile couples often consists of in vitro fertilization (IVF) but an estimated 70% of IVF cycles fail to produce a live birth. In an attempt to improve the live birth rate, the vast majority of IVF cycles performed in the United States involve the transfer of multiple embryos, a practice that increases the risk of multiple gestation pregnancy. This is a concern because multiple gestation pregnancies are associated with an increased incidence of maternal and fetal complications and significant cost associated with the care of preterm infants. As the ideal outcome of each IVF cycle is the birth of a single healthy baby, significant effort has focused on identifying embryos with the greatest developmental potential. To date, selection of euploid embryos using comprehensive chromosome screening (CCS) is the most promising approach while metabolomic and proteomic assessment of spent culture medium have the potential to noninvasively assess embryo viability. Endometrial gene expression profiling may help determine the optimal time to perform embryo transfer. While CCS has been implemented in some clinics, further development and optimization will be required before analysis of spent culture medium and endometrial gene expression profiling make the transition to clinical use. This review will describe efforts to identify embryos with the greatest potential to result in a healthy, live birth, with a particular emphasis on detection of embryo aneuploidy and metabolic profiling of spent embryo culture medium. Assessment of endometrial receptivity to identify the optimal time to perform embryo transfer will also be discussed.
许多不孕夫妇的治疗方法通常包括体外受精（IVF），但估计有 70%的 IVF 周期无法产生活产。为了提高活产率，美国绝大多数进行的 IVF 周期都涉及多个胚胎的转移，这种做法增加了多胎妊娠的风险。这是一个值得关注的问题，因为多胎妊娠与母婴并发症发生率增加以及早产儿护理相关的巨大成本有关。由于每个 IVF 周期的理想结果是单胎健康婴儿的出生，因此人们已经做出了巨大努力来识别具有最大发育潜力的胚胎。迄今为止，使用综合染色体筛查（CCS）选择整倍体胚胎是最有前途的方法，而对废弃培养物的代谢组学和蛋白质组学评估有可能无创地评估胚胎活力。子宫内膜基因表达谱分析可能有助于确定进行胚胎移植的最佳时间。虽然 CCS 已在一些诊所中实施，但在将废弃培养物分析和子宫内膜基因表达谱分析过渡到临床应用之前，还需要进一步的开发和优化。本文将描述鉴定具有最大潜力产生健康活产的胚胎的努力，特别强调胚胎非整倍体的检测和废弃胚胎培养物的代谢分析。还将讨论评估子宫内膜容受性以确定进行胚胎移植的最佳时间。
