第五天達到成熟囊胚，冷凍解凍後植入活產率約50%
第六天才達到成熟囊胚，冷凍解凍後植入活產率約30%
囊胚空腔程度&速度(day 5達到50%以上)是評估囊胚著床活產率最重要指標(compared to TE, ICM)
異常多核胚葉之胚胎仍有1/4會發育至囊胚
time lapse
EmbryoScope chamber無法明顯提高懷孕率
Fertil Steril. 2016 Aug 23. pii: S0015-0282(16)62525-6. doi: 10.1016/j.fertnstert.2016.07.1095. [Epub ahead of print]
Delayed blastulation, multinucleation, and expansion grade are independently associated with live-birth rates in frozen blastocyst transfer cycles.
Abstract
OBJECTIVE:
To identify blastocyst features independently predictive of successful pregnancy and live births with vitrified-warmed blastocysts.
DESIGN:
SETTING:
PATIENT(S):
Women undergoing a cycle with transfer of blastocysts vitrified using the Rapid-i closed carrier (n = 358).
INTERVENTION(S):
MAIN OUTCOME MEASURE(S):
Clinical pregnancy and live-birth rates analyzed using logistic regression analysis.
RESULT(S):
A total of 669 vitrified-warmed blastocysts were assessed. The survival rate was 95%. A mean of 1.7 ± 0.5 embryos were transferred. The clinical pregnancy, live-birth, and implantation rates were 55%, 46%, and 43%, respectively. The odds of clinical pregnancy (odds ratio [OR] 3.08; 95% confidence interval [CI], 1.88-5.12) and live birth (OR 2.93; 95% CI, 1.79-4.85) were three times higher with day-5 blastocysts versus slower-growing day-6 vitrified blastocysts, irrespective of patient age at cryopreservation. Blastocysts from multinucleated embryos were half as likely to result in a live birth (OR 0.46; 95% CI, 0.22-0.91). A fourfold increase in live birth was observed if an expanded blastocyst was available for transfer. The inner cell mass-trophectoderm score correlated to positive outcomes in the univariate analysis. The implantation rate was statistically significantly higher for day-5 versus day-6 vitrified blastocysts (50% vs. 29%, respectively).
CONCLUSION(S):
The blastocyst expansion grade after warming was predictive of successful outcomes independent of the inner cell mass or trophectoderm score. Delayed blastulation and multinucleation were independently associated with lower live-birth rates in frozen cycles. Implantation potential of the frozen blastocysts available should be included in the decision-making process regarding embryo number for transfer.
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