Valera María Ángeles, Garg Akhil, Bori Lorena, Meseguer Fernando, de Los Santos José María, Meseguer Marcos
IVI Foundation-Instituo de Investigación Sanitaria (IIS) La Fe, Research and Innovation, IVF Laboratory, Valencia, Spain; IVI-RMA Valencia, IVF Laboratory, Valencia, Spain.
IVI-RMA Valencia, IVF Laboratory, Valencia, Spain.
Fertil Steril. 2024 Dec;122(6):1037-1047. doi: 10.1016/j.fertnstert.2024.07.018. Epub 2024 Jul 22.
To compare the effect of a fully undisturbed culture strategy over a sequential one on embryo in vitro development and clinical outcomes in intracytoplasmic sperm injection (ICSI) cycles.
Retrospective cohort study.
University-affiliated private IVF center.
PATIENT(S): This study included 4,564 ICSI cycles performed over 5 years, including autologous and oocyte donation treatments with extended embryo culture until blastocyst in one of the two defined culture strategies.
INTERVENTION(S): Embryo cohorts were cultured in one of two culture systems: a fully undisturbed culture, including an incubator with integrated time-lapse technology, a one-step culture medium and embryo selection assisted by semi-automatic tools on the basis of embryo morphokinetics, or a sequential culture, using a conventional benchtop incubator, sequential media and traditional morphological evaluation under optical microscope. The effect of the culture strategies on embryo development and clinical outcomes was quantified by generalized estimated equations, controlling for possible confounders through the inverse probability of the treatment weighting method.
MAIN OUTCOME MEASURE(S): Weighted odds ratios (ORs) and 95% confidence intervals (CIs) for live birth rate after fresh single embryo transfer and the cumulative live birth rate. In addition, blastocyst development and morphology and other intermediate outcomes were also assessed.
RESULT(S): A significant positive association was found between the employment of undisturbed embryo culture and higher live birth rate in the first embryo transfer in both autologous (OR, 1.617; 95% CI, 1.074-2.435) and oocyte donation cycles (OR, 1.316; 95% CI, 1.036-1.672). Cumulative live birth rate after 1-year follow-up was also positively associated with the undisturbed culture strategy in oocyte donation cycles (OR, 1.5; 95% CI, 1.179-1.909), but not in autologous cycles (OR, 1.051; 95% CI, 0.777-1.423). Similarly, blastocyst rate, good morphology blastocyst rate, and utilization rate were positively associated with the employment of undisturbed culture in oocyte donation cycles, but not in autologous cycles.
CONCLUSION(S): These findings imply that a culture system combining integrated time-lapse incubators with a one-step culture medium may enhance the success rates of patients undergoing ICSI treatment by increasing the production of higher quality blastocysts and improving embryo selection while streamlining laboratory procedures and workflow.
比较完全不受干扰的培养策略与序贯培养策略对卵胞浆内单精子注射（ICSI）周期中胚胎体外发育及临床结局的影响。
回顾性队列研究。
大学附属私立试管婴儿中心。
本研究纳入了5年间进行的4564个ICSI周期，包括自体及供卵治疗，在两种既定培养策略之一中将胚胎培养至囊胚阶段。
胚胎队列在两种培养系统之一中培养：完全不受干扰的培养，包括配备集成延时技术的培养箱、一步培养基以及基于胚胎形态动力学由半自动工具辅助进行的胚胎选择；或序贯培养，使用传统台式培养箱、序贯培养基并在光学显微镜下进行传统形态学评估。通过广义估计方程量化培养策略对胚胎发育及临床结局的影响，并通过治疗权重法的逆概率控制可能的混杂因素。
新鲜单胚胎移植后的活产率及累积活产率的加权比值比（OR）和95%置信区间（CI）。此外，还评估了囊胚发育、形态及其他中间结局。
在自体（OR，1.617；95%CI，1.074 - 2.435）和供卵周期（OR，1.316；95%CI，1.036 - 1.672）中，不受干扰的胚胎培养与首次胚胎移植时较高的活产率之间均存在显著正相关。在供卵周期中，1年随访后的累积活产率也与不受干扰的培养策略呈正相关（OR，1.5；95%CI，1.179 - 1.909），但在自体周期中并非如此（OR，1.051；95%CI，0.777 - 1.423）。同样，在供卵周期中，囊胚率、优质形态囊胚率及利用率与采用不受干扰的培养呈正相关，但在自体周期中并非如此。
这些发现表明，将集成延时培养箱与一步培养基相结合的培养系统，可能通过增加高质量囊胚的产生、改善胚胎选择，同时简化实验室程序和工作流程，提高接受ICSI治疗患者的成功率。
