Ozbek Irem Yarali, Mumusoglu Sezcan, Polat Mehtap, Bozdag Gurkan, Sokmensuer Lale Karakoc, Yarali Hakan
Anatolia IVF and Women Health Center, Embryology, Ankara, Turkey.
Hacettepe University, Department of Obstetrics and Gynecology, Ankara, Turkey.
Reprod Biomed Online. 2021 May;42(5):892-900. doi: 10.1016/j.rbmo.2021.02.005. Epub 2021 Feb 14.
To assess incidence of abnormal cleavage among biopsied blastocysts; to compare euploidy rates of the blastocysts with abnormal and normal cleavage; and to compare single euploid blastocyst transfer (SEBT) outcome derived from embryos with normal or abnormal cleavage.
Retrospective analysis of prospectively collected data in a private IVF clinic. Consecutive 554 patients (749 cycles) undergoing preimplantation genetic testing for aneuploidy (n = 497; 671 cycles) or monogenic diseases (n = 57; 78 cycles) were included. All assessments for abnormal cleavage were carried out retrospectively; presence of abnormal cleavage was not a factor in deciding which euploid embryo to transfer. A total of 1015 blastocysts were biopsied and 295 SEBT procedures were carried out. Main outcome measure was live birth rate (LBR).
Incidence of reverse cleavage, direct cleavage, and reverse plus direct cleavage, were 7.7%, 6.4% and 2.3%, respectively. Of the 1015 biopsied blastocysts, 35.0% were euploid. Blastocysts with abnormal cleavage, in total, had a significantly higher euploidy rate compared with blastocysts with normal cleavage (44.6% [74/166] versus 33.1% [281/849]; P = 0.017). The LBR after SEBT with normal, reverse and direct cleavage, and direct cleavage plus reverse cleavage, was 133/238 (55.9%), 6/26 (23.1%), 8/24 (33.3%) and 0/3 (0.0%) (P < 0.001). Generalized estimating equation analysis showed that the presence of abnormal cleavage pattern was the only independent predictor of LBR (OR 0.316; 95% CI 0.115 to 0.867; P = 0.013).
Blastocysts with direct or reverse cleavage should be biopsied in preimplantation genetic testing cycles if they are morphologically eligible. Euploid blastocysts with abnormal cleavage, however, have approximately half the LBR of those euploid blastocyst with normal cleavage, hence, blastocysts with abnormal cleavage should have lower priority for transfer.
评估活检囊胚中异常分裂的发生率；比较异常分裂与正常分裂的囊胚的整倍体率；并比较由正常或异常分裂的胚胎衍生的单整倍体囊胚移植（SEBT）结局。
对一家私立体外受精诊所前瞻性收集的数据进行回顾性分析。纳入了连续554例患者（749个周期），这些患者接受了非整倍体植入前基因检测（n = 497；671个周期）或单基因疾病检测（n = 57；78个周期）。所有异常分裂的评估均为回顾性进行；异常分裂的存在不是决定移植哪个整倍体胚胎的因素。共活检了1015个囊胚，并进行了295例SEBT手术。主要结局指标是活产率（LBR）。
反向分裂、直接分裂以及反向加直接分裂的发生率分别为7.7%、6.4%和2.3%。在1015个活检囊胚中，35.0%为整倍体。总体而言，异常分裂的囊胚的整倍体率显著高于正常分裂的囊胚（44.6% [74/166] 对33.1% [281/849]；P = 0.017）。正常分裂、反向分裂、直接分裂以及直接分裂加反向分裂后的SEBT活产率分别为133/238（55.9%）、6/26（23.1%）、8/24（33.3%）和0/3（0.0%）（P < 0.001）。广义估计方程分析表明，异常分裂模式的存在是LBR的唯一独立预测因素（OR 0.316；95% CI 0.115至0.867；P = 0.013）。
在植入前基因检测周期中，如果形态学上符合条件，具有直接或反向分裂的囊胚应进行活检。然而，异常分裂的整倍体囊胚的活产率约为正常分裂的整倍体囊胚的一半，因此，异常分裂的囊胚在移植时应具有较低的优先级。
