第4天桑葚期胚胎分級與懷孕率

A,B: 極優 (compact)----懷孕率44%

C,D: 優 (partial compact)----懷孕率36%
E: 中 (no compact, >8cell)----懷孕率25%
F: 差 (no compact, <8cell)----懷孕率0%

http://humrep.oxfordjournals.org/content/23/7/1505.full

Day 4 embryo selection is equal to Day 5 using a new embryo scoring system validated in single embryo transfers

1. Deanne Feil1,2,3, 
2. Richard C. Henshaw2 and 
3. Michelle Lane1,2

+Author Affiliations

1. ¹Department of Obstetrics and Gynaecology, Research Centre for Reproductive Health, The University of Adelaide, Adelaide, Australia
2. ²Repromed, Adelaide, Australia

1. 3Correspondence address. E-mail: deanne.feil@adelaide.edu.au

• Received April 6, 2007.
• Revision received December 6, 2007.
• Accepted December 13, 2007.

 

Next Section

Abstract

BACKGROUND Single embryo transfers (SETs) require the most viable embryo from a cohort to be selected. Day 4 embryos may provide a selection advantage similar to blastocyst transfer as embryos are replaced post-embryonic genome activation and into the uterus where they would normally reside. However, there is currently no adequate morphological system to assess Day 4 embryos. Therefore, we developed an assessment system for Day 4 embryos and retrospectively assessed Day 4 SET success rates compared with Day 5 SETs.

METHODS Embryos (n = 996 after IVF or ICSI) were assessed on Day 4 of development, prior to implementing Day 4 embryo transfers, to obtain a descriptive range of embryo morphologies observed at this time point. A morphological scoring system was developed from this. All patients having an SET after extended culture (Day 4, n = 124 or Day 5, n = 193), at Repromed, Adelaide, Australia, during June 2006–January 2007 were analysed for pregnancy outcome. Ongoing pregnancy was determined by fetal cardiac activity at 6–8 weeks after oocyte collection.

RESULTS Day 4 and 5 SETs resulted in similar ongoing pregnancy rates of 38.7% and 32.1%, respectively.

CONCLUSIONS A Day 4 scoring system was successfully developed and implemented. Day 4 SETs were found to be a viable option or alternative to Day 5 SETs with no difference in pregnancy rates.

Figure 1:

Scoring system developed for Day 4 embryos. Grade 1: early blastocyst, visible signs of cavitation occurring (A) or completely compacted embryo, lacking negative morphological anomalies (B), e.g. vacuolation, excessive fragmentation, large number of excluded cells and self-cavitation of cells. Grade 2: Grade 1 compacted morula, with some morphological anomalies, e.g. one of the following present: vacuolation, excessive fragmentation, excluded cells, self-cavitation of cells or at least an eight-cell embryo, with partial compaction present or the majority of cells at least showing signs of compaction (C and D). Grade 3: partially compacted embryo with vacuoles or excessive fragmentation present or eight-cell embryo or greater, with no signs of compaction evident (E). Grade 4: embryos with eight cells or greater, with no signs of compaction and vacuoles or excess fragments or embryos with less than eight cells, and no signs of compaction (F)

Figure 3:

Pregnancy rates using developed Day 4 scoring system with signal embryo transfers. Numbers in columns indicate the number of single embryo transfers performed in each group