Day 1, 2胚胎形態並無法有效評估胚胎之囊胚發育率

Day 1(IVF-IVF後18h)---評估2PN

早期分裂(early cleavage)---ICSI後26h有分裂為2-cell 屬於早期分裂(early cleavage)

Day2 (IVF-ICSI後44h)---評估胚葉細胞數目(4 cells)優於> or <4celll

Day 2胚胎形態中，胚葉細胞數目(4 cells) & early cleavage 比細胞碎片fragment (<50%)更有效評估胚胎之囊胚發育率

Day 1, 2胚胎形態並無法有效評估胚胎之囊胚發育率

http://humrep.oxfordjournals.org/content/22/7/1973.full

Limited value of morphological assessment at days 1 and 2 to predict blastocyst development potential: A prospective study based on 4042 embryos

1. F. Guerif1, 
2. A. Le Gouge2, 
3. B. Giraudeau2, 
4. J. Poindron1, 
5. R. Bidault1,
6. O. Gasnier1 and 
7. D. Royere1,3

+Author Affiliations

1. ¹Service de Médecine et Biologie de la Reproduction, CHU Bretonneau, 2 Boulevard Tonnelle, 37000 Tours, France
2. ²INSERM CIC 202, Université François Rabelais de Tours, CHRU de Tours, France

1. 3Correspondence address. Tel: +33-247-474-746; Fax: +33-247-478-484; E-mail:royere@med.univ-tours.fr

• Received December 11, 2006.
• Revision received March 14, 2007.
• Accepted March 29, 2007.

Next Section

Abstract

BACKGROUND Non-invasive and routine developmental markers are available to select the most viable embryo; however their respective values in terms of blastocyst development potential remain difficult to distinguish.

METHODS During this prospective study, the sequential growth of 4042 embryos individually cultured from day 1 to day 5/6 was recorded. Pronuclear morphology on day 1, and early cleavage, cell number and fragmentation rate on day 2 were evaluated for each zygote. Additionally, blastocyst transfers were analysed with regard to their implantation ability and early embryo development parameters.

RESULTS Once adjusted to each other, each of the four parameters remained related to blastocyst development. Early cleavage and cell number on day 2 were the most powerful parameters to predict the development of a good morphology blastocyst at day 5. Moreover, whereas transfers of a good morphology blastocyst were associated with high implantation and live birth rates, parameters of early development were not helpful in predicting their implantation ability.

CONCLUSIONS The combination of all four parameters allowed the prediction of blastocyst development with an area under the receiver operating characteristics curve of 0.688, which represents a fairly low prediction of embryo viability. Such results indicate that it is necessary to search for additional criteria, including the ability of the blastocyst to develop.

Table 1:

Associations between pronuclear morphology, early cleavage, embryo morphology and blastocyst development at day 5/6—univariate analysis (n = 4042 embryos)

	Embryos,	Blastocysts at day 5/6		P-value
	n	n	%
Pronuclear morphology (day 1)				<0.0001
Pattern 0 zygotes	717	402	56
Non-pattern 0 zygotes	3325	1360	41
Early cleavage (day 2)				<0.0001
Early-cleavage embryos	1298	803	62
Non-early-cleavage embryos	2744	959	35
Number of cells (day 2)				<0.0001
2–3 cells	1637	511	31
4 cells	1641	961	59
5–8 cells	764	290	38
Fragmentation rate (day 2)				<0.0001
<20% fragmentation	1916	956	50
20–50% fragmentation	1583	654	41
>50% fragmentation	543	152	28

Table 2:

Associations between pronuclear morphology, early cleavage, embryo morphology and blastocyst development at day 5/6—multivariate analysis (n = 4042 embryos)

	OR*	95% CI**	P-value	Overall P
Pronuclear morphology (day 1)
Pattern 0 zygotes	1.00	–	–
Non-pattern 0 zygotes	0.74	0.62–0.88	0.0007
Early cleavage (day 2)
Early-cleavage embryos	1.00	–	–
Non-early-cleavage embryos	0.44	0.38–0.51	<0.0001
Number of cells (day 2)				<0.0001
4 cells	1.00	–	–
2–3 cells	0.46	0.40–0.54	<0.0001
5–8 cells	0.46	0.39–0.56	<0.0001
Fragmentation rate (day 2)				<0.0001
<20% fragmentation	1.00	–	–
20–50% fragmentation	0.81	0.70–0.93	0.0029
>50% fragmentation	0.50	0.40–0.62	<0.0001

• *Lower than 1 is associated with a lower chance of obtaining a blastocyst; **CI, confidence interval.

Table 3:

Associations between pronuclear morphology, early cleavage, embryo morphology and good morphology blastocysts—univariate analysis (n = 1762 blastocysts)

	Total blastocystat day 5/6	B3–B6 A/B A/B blastocysts at day 5		P-value
	n	n	%
Pronuclear morphology (day 1)				0.0002
Pattern 0 zygotes (2 PN)	402	162	40
Non-pattern 0 zygotes (2 PN)	1360	414	30
Early cleavage (day 2)				<0.0001
Early-cleavage embryos	803	377	47
Non-early-cleavage embryos	959	199	21
Number of cells (day 2)				<0.0001
2–3 cells	511	71	14
4 cells	961	420	44
5–8 cells	290	85	29
Fragmentation rate (day 2)				0.0019
<20% fragmentation	956	345	36
20–50% fragmentation	654	194	30
>50% fragmentation	152	37	24

Table 4:

Associations between pronuclear morphology, early cleavage, embryo morphology and good morphology blastocysts—multivariate analysis (n = 1762 blastocysts)

	OR*	95% CI**	P-value	Overall P
Early cleavage (day 2)
Early-cleavage embryos	1.00
Non-early-cleavage embryos	0.40	0.32–0.50	<0.0001
Number of cells (day 2)				<0.0001
4 cells	1.00
2–3 cells	0.30	0.22–0.40	<0.0001
5–8 cells	0.54	0.41–0.72	<0.0001

• *Lower than 1 is associated with a lower chance of obtaining a good morphology blastocyst (B3–B6 blastocyst A/B, A/B at day 5); **CI, confidence interval.