一階段胚養液(continual culture medium)囊胚率略優於二階段式培養液(sequential culture medium)
mean blastocyst rate: 38.7% ± 29.7% vs. 34.3% ± 29.4%; p = 0.01

但二者活產率類似   Delivery rate (n = 244/903, 27.0% vs. 129/475, 27.2%, NS

J Assist Reprod Genet. 2018 May 3. doi: 10.1007/s10815-018-1195-4. [Epub ahead of print]

Continuous embryo culture elicits higher blastulation but similar cumulative delivery rates than sequential: a large prospective study.

Cimadomo D1, Scarica C2, Maggiulli R3, Orlando G3, Soscia D3, Albricci L3, Romano S3, Sanges F3, Ubaldi FM3, Rienzi L3.

Author information

Abstract

PURPOSE:

To assess whether continuous embryo culture involves better embryological and/or clinical outcomes than sequential.

METHODS:

Prospective study at a private IVF center. All consecutive IVF cycles (September 2013-2015) fulfilling the inclusion criteria underwent embryo culture in either Continuous-Single-Culture-Media (CSCM, n = 972) or sequential media (Quinn's Advantage, n = 514), respectively. ICSI, blastocyst culture in either standard (MINC) or undisturbed (Embryoscope) incubation, transfer (until September 2016), and pregnancy follow-up (until September 2017) were performed. When aneuploidy testing was required, trophectoderm biopsy and qPCR were performed. Sub-analyses and logistic regression corrected for confounders were performed. The primary outcomes were overall blastocyst rate per oocyte and mean blastocyst rate per cycle. The sample size was defined to reach 95 and 80% statistical power for the former and the latter outcome, respectively. Secondary outcomes were euploidy (if assessed), cumulative delivery rates, gestational age, and birthweight.

RESULTS:

Continuous embryo culture resulted into a higher overall blastocyst rate per inseminated oocyte than sequential (n = 2211/5841, 37.9% vs. 1073/3216, 33.4%; p < 0.01), confirmed also from a cycle-based analysis (mean blastocyst rate: 38.7% ± 29.7% vs. 34.3% ± 29.4%; p = 0.01). The continuous media (OR = 1.23), the undisturbed incubation system (OR = 1.22), the maternal age (OR = 0.92), and the sperm factor (OR = 0.85) were outlined as positive predictors of blastulation. However, the cumulative delivery rates per ended cycle (i.e., delivery achieved or no blastocyst produced or left; > 90%) were comparable in the two groups (n = 244/903, 27.0% vs. 129/475, 27.2%). The neonatal outcomes were similar.

CONCLUSIONS:

Continuous culture involves better embryological but similar clinical outcomes than sequential. This large prospective study supports the absence of clinical disparity among the two approaches.