PDF(Sci-hub)
Abstract：
OBJECTIVE: To investigate the between-laboratory reproducibility of embryo selection/deselection effectiveness using qualitative and quantitative time-lapse parameters.
METHODS: A systematic search was performed on MEDLINE, EMBASE, and the Cochrane Library (up to February 2020) without restriction on date, language, document type, and publication status. Measuring outcomes included implantation, blastulation, good-quality blastocyst formation, and euploid blastocyst.
RESULTS: We detected 6 retrospective cohort studies externally validating the first clinical time-lapse model (Meseguer) emphasizing quantitative parameters, of which 3 (including one involving 2 independent centers) were included for the pooled analysis. Receiver operating characteristics analysis showed reduced predictive power of the model when either including or not including sister clinic validation. Fifteen cohort studies evaluating qualitative parameters were included for meta-analysis, and the mean Newcastle-Ottawa Scale was 5.3. Overall, meta-analysis showed significantly adverse association between the presence of ≥ 1 cleavage abnormalities and embryo implantation rates (11 studies, n = 7266; RR = 0.39[0.28, 0.55]95% CI; I2 = 57%). Further analysis showed adverse impacts of direct cleavage (7 studies, n = 7065; RR = 0.28 [0.15, 0.54] 95% CI; I2 = 46%), reverse cleavage (2 studies, n = 3622; RR = 0.16 [0.03, 0.75] 95% CI; I2 = 0%), chaotic cleavage (2 studies, n = 3643; RR = 0.11 [0.02, 0.69] 95% CI; I2 = 24%), and multinucleation (5 studies, n = 2576; RR = 0.59 [0.50, 0.69] 95% CI; I2 = 0%), but not the < 6 intercellular contact points at the 4-cell stage (1 study, n = 185; RR = 0.17 [0.02, 1.15] 95% CI).
CONCLUSIONS: Qualitative time-lapse parameters are reliably associated with embryo developmental potential among laboratories, whereas the reproducibility of time-lapse embryo selection model that emphasizes quantitative parameters may be compromised when externally applied.
METHODS: A systematic search was performed on MEDLINE, EMBASE, and the Cochrane Library (up to February 2020) without restriction on date, language, document type, and publication status. Measuring outcomes included implantation, blastulation, good-quality blastocyst formation, and euploid blastocyst.
RESULTS: We detected 6 retrospective cohort studies externally validating the first clinical time-lapse model (Meseguer) emphasizing quantitative parameters, of which 3 (including one involving 2 independent centers) were included for the pooled analysis. Receiver operating characteristics analysis showed reduced predictive power of the model when either including or not including sister clinic validation. Fifteen cohort studies evaluating qualitative parameters were included for meta-analysis, and the mean Newcastle-Ottawa Scale was 5.3. Overall, meta-analysis showed significantly adverse association between the presence of ≥ 1 cleavage abnormalities and embryo implantation rates (11 studies, n = 7266; RR = 0.39[0.28, 0.55]95% CI; I2 = 57%). Further analysis showed adverse impacts of direct cleavage (7 studies, n = 7065; RR = 0.28 [0.15, 0.54] 95% CI; I2 = 46%), reverse cleavage (2 studies, n = 3622; RR = 0.16 [0.03, 0.75] 95% CI; I2 = 0%), chaotic cleavage (2 studies, n = 3643; RR = 0.11 [0.02, 0.69] 95% CI; I2 = 24%), and multinucleation (5 studies, n = 2576; RR = 0.59 [0.50, 0.69] 95% CI; I2 = 0%), but not the < 6 intercellular contact points at the 4-cell stage (1 study, n = 185; RR = 0.17 [0.02, 1.15] 95% CI).
CONCLUSIONS: Qualitative time-lapse parameters are reliably associated with embryo developmental potential among laboratories, whereas the reproducibility of time-lapse embryo selection model that emphasizes quantitative parameters may be compromised when externally applied.
摘要：
目的：使用定性和定量延时参数研究胚胎选择/去选择有效性的实验室间可重复性。
方法：对MEDLINE进行了系统搜索，EMBASE,和Cochrane图书馆（截至2020年2月），没有日期限制，语言,文档类型,和出版状态。测量结果包括植入，囊胚形成,优质的胚泡形成，和整倍体胚泡。
结果：我们检测到6项回顾性队列研究，外部验证了第一个强调定量参数的临床延时模型（Meseguer），其中3个(包括1个涉及2个独立中心)纳入合并分析.接收器操作特性分析显示，当包括或不包括姐妹临床验证时，模型的预测能力降低。15项评估定性参数的队列研究被纳入荟萃分析，平均纽卡斯尔-渥太华量表为5.3。总的来说,荟萃分析显示，≥1卵裂异常的存在与胚胎着床率之间存在显着不利关联（11项研究，n=7266；RR=0.39[0.28，0.55]95%CI；I2=57%）。进一步分析显示直接裂解的不利影响(7项研究，n=7065；RR=0.28[0.15，0.54]95%CI；I2=46%），反向裂解(2项研究，n=3622；RR=0.16[0.03，0.75]95%CI；I2=0%），混沌分裂(2项研究，n=3643；RR=0.11[0.02，0.69]95%CI；I2=24%），和多核化(5项研究，n=2576；RR=0.59[0.50，0.69]95%CI；I2=0%），但不是4细胞阶段的<6个细胞间接触点(1项研究，n=185；RR=0.17[0.02，1.15]95%CI）。
结论：定性延时参数与实验室中的胚胎发育潜力可靠相关，而强调定量参数的延时胚胎选择模型的可重复性在外部应用时可能会受到影响。
方法：对MEDLINE进行了系统搜索，EMBASE,和Cochrane图书馆（截至2020年2月），没有日期限制，语言,文档类型,和出版状态。测量结果包括植入，囊胚形成,优质的胚泡形成，和整倍体胚泡。
结果：我们检测到6项回顾性队列研究，外部验证了第一个强调定量参数的临床延时模型（Meseguer），其中3个(包括1个涉及2个独立中心)纳入合并分析.接收器操作特性分析显示，当包括或不包括姐妹临床验证时，模型的预测能力降低。15项评估定性参数的队列研究被纳入荟萃分析，平均纽卡斯尔-渥太华量表为5.3。总的来说,荟萃分析显示，≥1卵裂异常的存在与胚胎着床率之间存在显着不利关联（11项研究，n=7266；RR=0.39[0.28，0.55]95%CI；I2=57%）。进一步分析显示直接裂解的不利影响(7项研究，n=7065；RR=0.28[0.15，0.54]95%CI；I2=46%），反向裂解(2项研究，n=3622；RR=0.16[0.03，0.75]95%CI；I2=0%），混沌分裂(2项研究，n=3643；RR=0.11[0.02，0.69]95%CI；I2=24%），和多核化(5项研究，n=2576；RR=0.59[0.50，0.69]95%CI；I2=0%），但不是4细胞阶段的<6个细胞间接触点(1项研究，n=185；RR=0.17[0.02，1.15]95%CI）。
结论：定性延时参数与实验室中的胚胎发育潜力可靠相关，而强调定量参数的延时胚胎选择模型的可重复性在外部应用时可能会受到影响。
