囊胚TE細胞形狀比bloastocoele & ICM更可評估胚胎之品質與著床率

囊胚3項指標;  blastocoele expansion, trophectoderm (TE), inner cell mass (ICM). 

囊胚TE細胞形狀比bloastocoele & ICM更可評估胚胎之品質與著床率
胚胎著床需健康之TE cells
TE cells 會分泌hCG進一步影響子宮內膜環境

http://humrep.oxfordjournals.org/content/26/12/3289.full

Trophectoderm morphology: an important parameter for predicting live birth after single blastocyst transfer

1. A. Ahlström*, 
2. C. Westin, 
3. E. Reismer, 
4. M. Wikland and 
5. T. Hardarson

+Author Affiliations

1. Fertility Centre Scandinavia, Carlanderska Hospital, PO Box 5418, S-402 29 Göteborg, Sweden

1. ↵*Correspondence address. E-mail: aish.ahlstrom@fcivf.com

• Received May 17, 2011.
• Revision received August 30, 2011.
• Accepted September 6, 2011.

 

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Abstract

BACKGROUND In order to select the best blastocyst for transfer, in humans, three morphological parameters have routinely been used, i.e. degree of blastocoele expansion and appearance of both the trophectoderm (TE) and the inner cell mass (ICM). Although it has been shown that blastocysts with highest scores for all three parameters achieve highest implantation rates, their independent ability to predict pregnancy outcome remains unclear.

METHOD This study is a retrospective analysis of 1117 fresh day 5 single blastocyst transfers and their live birth outcome related to each morphological parameter.

RESULTS All three parameters had a significant effect on live birth however, once adjusted for known significant confounders, it was shown that TE was the only statistically significant independent predictor of live birth outcome.

CONCLUSIONS This study has shown, for the first time, the predictive strength of TE grade over ICM for selecting the best blastocyst for embryo replacement. It may be that, even though ICM is important, a strong TE layer is essential at this stage of embryo development, allowing successful hatching and implantation.

Table III

Effect of Expansion, ICM and TE separately analysed and adjusted for known and significant confounders (age, GQE, FSH total dose and number of earlier cycles).

Variable	Value	Live birth, % (n)	OR (95% CI)	P-value
Expansion	0 + 1 + 2	23.7 (58)
	3	36.4 (148)	1.57 (1.07–2.29)	0.0196
	4	46.5 (216)	1.38 (1.04–1.83)	0.0259
Inner cell mass	A	45.3 (301)
	B	31.0 (62)	0.62 (0.44–0.89)	0.0082
	C	14.3 (1)	0.38 (0.05–3.05)	NS
Trophectoderm cells	A	49.9 (234)
	B	33.9 (128)	0.56 (0.41–0.74)	0.0001
	C	8.0 (2)	0.17 (0.04–0.76)	0.0198

• GEE models have been used as they allow for adjustment of within-individual correlation.
• For Expansion OR for 3 versus 0 + 1 + 2 and 4 + 5 versus 3 are presented.
• For ICM and TE cells OR for 1 versus 0 and 2 versus 1 are presented.
• Expansion: 0 was categorized together with 1 due to very few observations with 0 category and no occurrence of event in 0 category; 2 was categorized together with 0 and 1 due to no significant difference in the step 0 + 1 versus 2 in the analysis.