IVF-ET中观察胚胎早期卵裂预测胚胎发育潜力的研究

目的:探讨通过观察胚胎早期卵裂预测胚胎发育潜力,以期得到较好的临床妊娠结局。方法:对117个IVF、IC-SI周期,1 169个胚胎在受精24~28h的早期卵裂及后期发育情况进行观察,并根据早期卵裂情况将胚胎分为早期卵裂组、未早期卵裂组和原核(PN)未消失组,最终结合早期卵裂,第2天(D2)、第3天(D3)胚胎评分等情况选择适合移植的胚胎进行移植,共移植102个周期。同时对优胚率、妊娠率、种植率等指标进行比较。结果:①早期卵裂组D3优胚率高于其它两组(P<0.05);②全部移植早期卵裂胚胎组和全部移植未早期卵裂胚胎组的生化妊娠率高于全部移植PN未消失胚胎组(P<0.05),但临床妊娠率差异无统计学意义(P>0.05);③移植2~3个优胚与移植1个优胚和1~2个非优胚的周期妊娠率和种植率差异无统计学意义(P>0.05),但都高于未移植优胚周期(P<0.01)。结论:观察胚胎早期卵裂可有效预测胚胎发育潜力,有利于挑选适合移植的胚胎,从而获得较高的妊娠率,但对临床妊娠率的影响不明显,临床妊娠率主要取决于优胚率。

The value of early cleavage in predicting implantation potential of embryos and pregnancy rate

Objective： To explore the value of early cleavage in predicting the implantation potential of embryos and pregnancy rate.Methods： A total of 1 169 embryos from 117 IVF/ICSI cycles between December 2008 and January 2010 were assessed,and their early cleavage and morphology of day 2 and day 3 were inspected.All these embryos were grouped into three groups according to their cleavage between 24 and 28 hour after insemination： early-cleaved group,non early-cleaved group and PN-existed group.Transferred embryos were selected according to early cleavage combined with morphology of day 2 and day 3.Meanwhile,the high-quality embryo rate,pregnancy and implantation rates were observed in 102 transfer cycles.Results： The embryo quality of early-cleaved group was significant higher than those of the other two groups（P0.05）.The pregnancy rates of early-cleaved group and non early-cleaved group were significantly higher than that of the PN-existed group,but differences in clinical pregnancy rates among the three groups were not significant（P all 0.05）.The pregnancy and implantation rates had no significant differences between the transfer cycles with 2 to 3 high-quality embryos and those with single high-quality embryo and 1 to 2 other embryos（P0.05）,but higher than those without a high-quality embryo（P0.01）.Conclusion： The method of observing early cleavage can predict the implantation potential of embryos effectively.It is helpful to select the embryos for transfer,resulting in higher pregnancy rates.But the clinical pregnancy rates are not close correlated with early cleavage but determined by the rate of high-quality embryos.