Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Lee Womens' Hospital, Taichung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
Biomed J. 2022 Feb;45(1):190-199. doi: 10.1016/j.bj.2021.01.002. Epub 2021 Jan 15.
The presence of only morphologically poor embryos (MPEs) on day3 is common in autologous in vitro fertilization (IVF), particularly among p Tel: 886-7-7317123 Ext. 8916. Fax: 886-7-7322915.atients who have advanced maternal age or are poor responders. However, there are limited data regarding the disposition of embryos from patients who only produced MPEs on day3. The present study was designed to investigate the possible benefits of extended culturing MPEs. Try to detect whether the extended culture (day4 or day5 culture) can improve the live birth rate per cycle?
This retrospective, observational, single-center, cohort study examined 224 IVF/intracytoplasmic sperm injection (ICSI) cycles between January 2010 and June 2015, in which women only produced MPEs on day3. A total of 544 MPEs were analyzed. The defines a day3 embryo as an MPE if it fails to develop to eight cells, blastomeres of equal size, and less than 20% cytoplasmic fragments. Of the 224 cycles, 89 (39.7%) underwent fresh embryo transfer on day3, and 135 (60.3%) underwent extended culture. Of the 135 extended cultures, 54 cycles (40.0%) experienced day4, or day5 embryo transfer, 16 cycles (11.9%) had all embryos frozen, and 65 cycles (48.1%) had total embryo arrest.
Analysis of patient baseline demographic data, cycle characteristics, and cycle outcomes for day3 transfer group and extended culture group indicated that a higher body mass index in the day3 transfer group was the only significant difference (p = 0.006). Both fresh transfer groups had low live birth rates (LBRs) (4.5% vs. 7.4% p = 0.46). After extended culture, 65 cycles (48.1%) were cancelled because the embryos exhibited developmental arrest and 70 cycles (51.9%) grew to day4 or day5. Thirteen frozen embryo transfer (FET) cycles and 22 frozen blastocysts derived from MPEs were thawed. There were more high-quality embryos (p < 0.001), higher implantation rates (IRs) (p = 0.038), and higher LBRs (p = 0.042) for embryos that underwent FET cycles. MPES in extended culture transfer have favorable survival than MPES in day3 transfer.
The extended culture of MPEs in fresh transfer cycles did not increase the LBR. However, younger females with the extended culture of MPEs followed by FET resulted in significantly higher LBRs and may be a feasible strategy to improve outcomes for patients with poor embryo quality. However, day3 embryo transfer may be a better choice if a fresh transfer is unrestricted and avoid the cycle cancellation. Extended culture may decrease to the transfer of developmental potential arrest embryos to patients.
仅在第 3 天出现形态学上较差的胚胎（MPEs）在自体体外受精（IVF）中很常见，尤其是在高龄产妇或反应不良的患者中。然而，关于仅在第 3 天产生 MPEs 的患者的胚胎处理的数据有限。本研究旨在探讨延长培养 MPEs 的可能益处。尝试检测延长培养（第 4 天或第 5 天培养）是否可以提高每个周期的活产率？
本回顾性、观察性、单中心、队列研究分析了 2010 年 1 月至 2015 年 6 月期间进行的 224 个 IVF/胞浆内精子注射（ICSI）周期，其中女性仅在第 3 天产生 MPEs。共分析了 544 个 MPEs。第 3 天的胚胎定义为如果它未能发育到 8 个细胞、大小相等的卵裂球和小于 20%的细胞质碎片。在 224 个周期中，89 个（39.7%）在第 3 天进行了新鲜胚胎移植，135 个（60.3%）进行了延长培养。在 135 个延长培养中，54 个周期（40.0%）进行了第 4 天或第 5 天的胚胎移植，16 个周期（11.9%）将所有胚胎冷冻，65 个周期（48.1%）出现了胚胎完全停滞。
对第 3 天移植组和延长培养组的患者基线人口统计学数据、周期特征和周期结局进行分析表明，第 3 天移植组中较高的体重指数是唯一显著差异（p=0.006）。两组新鲜移植组的活产率均较低（4.5%对 7.4%，p=0.46）。延长培养后，由于胚胎发育停滞，65 个周期（48.1%）被取消，70 个周期（51.9%）生长到第 4 天或第 5 天。13 个冷冻胚胎移植（FET）周期和 22 个来自 MPEs 的冷冻囊胚被解冻。FET 周期的胚胎具有更多的优质胚胎（p<0.001）、更高的着床率（IRs）（p=0.038）和更高的活产率（p=0.042）。与第 3 天移植相比，延长培养转移的 MPEs 具有更好的生存能力。
新鲜移植周期中 MPEs 的延长培养并未增加活产率。然而，对于接受 MPEs 延长培养后进行 FET 的年轻女性，活产率显著提高，这可能是改善胚胎质量较差患者结局的可行策略。然而，如果新鲜移植不受限制，并且避免周期取消，第 3 天的胚胎移植可能是更好的选择。延长培养可能会减少发育潜能停滞胚胎向患者的转移。
