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.
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 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 |
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