囊胚植入前膨脹與否可能是評估囊胚著床活產率之最重要指標

囊胚植入前膨脹與否與著床率高度相關, 活產相關性高於其他指標
懷孕率指標強弱依序:
膨脹>非膨脹
Day5>Day6
TE score, ICM, 多核

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.

Desai N1, Ploskonka S2, Goodman L2, Attaran M2, Goldberg JM2, Austin C2, Falcone T2.

Author information

Abstract

OBJECTIVE:

To identify blastocyst features independently predictive of successful pregnancy and live births with vitrified-warmed blastocysts.

DESIGN:

Retrospective study.

SETTING:

Academic hospital.

PATIENT(S):

Women undergoing a cycle with transfer of blastocysts vitrified using the Rapid-i closed carrier (n = 358).

INTERVENTION(S):

None.

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 four -fold 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.

Table 2Variables affecting clinical pregnancy and live-birth rates in frozen-embryo transfer cycles.

Variable	OR (95% CI)	P value
Clinical pregnancy rate
D5 vs. D6	2.86 (1.82–4.50)	<.001
No. embryo transferred (per embryo)	2.26 (1.48–3.49)	<.001
Patient age at freeze (y)	0.40 (0.13–2.50)	.09
Presence of MU	0.51 (0.28–0.93)	.04
Blast expansion grade (all grades)	7.10 (2.73–19.5)	<.001
Per grade increase	1.63 (1.28–2.10)	<.001
ICM grade (per score increase)	0.63 (0.46–0.85)	.003
TE grade (per score increase)	0.50 (0.33–0.74)	<.001
Culture chamber	1.14 (0.74–1.75)	.59
Live-birth rate
D5 vs. D6	2.83 (1.80–4.49)	<.001
No. embryo transfer (per embryo)	1.90 (1.25–2.91)	.003
Patient age at freeze (y)	0.26 (0.09–0.74)	.01
Presence of MU	0.44 (0.22–0.80)	.01
Blastocyst expansion grade (all grades)	7.19 (2.68–20.7)	<.001
Per grade increase	1.64 (1.28–2.13)	<.001
ICM grade (per score increase)	0.65 (0.47–0.88)	.006
TE grade (per score increase)	0.44 (0.28–0.66)	<.001
Culture chamber	1.20 (0.79–1.86)	.45