Division of Reproductive Endocrinology and In Vitro Fertilization (IVF), Department of Obstetrics and Gynecology Lady Davis Carmel Medical Center, Haifa, Israel.
Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
J Obstet Gynaecol Res. 2023 Jun;49(6):1560-1570. doi: 10.1111/jog.15639. Epub 2023 Mar 23.
To examine the implantation potential of fragmented embryos that underwent morphokinetic evaluation in a time-lapse incubator.
A retrospective study analyzing 4210 Day 5 embryos which were incubated in a time-lapse incubator, between 2013 and 2019. Embryos with more than 5% fragmentation (379 embryos) were included in the study. Embryos selected using the general model and re-examined by our in-house model. Embryo fragmentation percentage was documented from the first cell-division (start fragmentation) to its maximal percentage (final fragmentation), and the ratio between them (fragmentation worsening). Data were analyzed with relation to embryo development, embryos transfer or freezing, clinical pregnancy, and live birth rates.
Embryo fragmentation and morphokinetics were found to be independent variables for clinical pregnancy achievements. A higher fragmentation worsening was noted among discarded embryos compared to transferred or frozen embryos (p < 0.0001). Advanced maternal age had a significant negative effect on fragmentation (p < 0.001). Missed abortion rates were similar in fragmented embryos that implanted compared with the overall population. Live birth rates were comparable among embryos which were selected for transfer or freezing by their morphokinetics and had different severity of fragmentation.
Our study shows that fragmented embryos have a potential to implant and therefore should be selected for transfer. Laboratories which do not use time-lapse incubators for embryo selection, should consider transferring fragmented embryos, since they have an acceptable chance for live birth. Calculation of fragmentation worsening may enhance our ability to predict embryo development. Further research with analysis of more fragmented embryo maybe beneficial. This study was approved by the local ethics committee No. 0010-19 CMC on April 18th, 2019.
研究在时间 lapse 培养箱中进行形态动力学评估的碎片化胚胎的着床潜能。
回顾性分析了 2013 年至 2019 年在时间 lapse 培养箱中培养的 4210 个第 5 天胚胎。纳入研究的胚胎碎片率大于 5%（379 个胚胎）。使用通用模型选择胚胎，并使用我们内部的模型重新检查。记录胚胎从第一次分裂（起始碎片）到最大碎片率（最终碎片）的碎片百分比，并记录它们之间的比例（碎片恶化）。分析胚胎发育、胚胎转移或冷冻、临床妊娠和活产率与数据的关系。
胚胎碎片和形态动力学是临床妊娠成功的独立变量。与转移或冷冻的胚胎相比，废弃的胚胎碎片恶化程度更高（p<0.0001）。高龄产妇的碎片率有显著的负向影响（p<0.001）。与总体人群相比，着床的碎片化胚胎的自然流产率相似。通过形态动力学选择进行转移或冷冻的胚胎的活产率相似，而碎片率严重程度不同。
我们的研究表明，碎片化胚胎有植入的潜力，因此应该选择进行转移。不使用时间 lapse 培养箱进行胚胎选择的实验室，应该考虑转移碎片化胚胎，因为它们有可接受的活产机会。计算碎片恶化程度可能会提高我们预测胚胎发育的能力。进一步研究更多碎片化胚胎可能会有所帮助。本研究于 2019 年 4 月 18 日经当地伦理委员会 No. 0010-19 CMC 批准。
