Abstract：
UNASSIGNED: Selection of high-quality blastocysts is the most important factor determining the success of assisted reproductive technology. The objective of this study is to assess the values of blastocyst morphological quality and development speed for predicting euploidy and clinical pregnancy outcome.
UNASSIGNED: A total of 155 preimplantation genetic testing cycles including 959 blastocysts and 154 euploid blastocyst transfer cycles conducted between January 2018 and December 2019 were retrospectively analysed. The associations of blastocyst morphological quality and development speed (D) with chromosomal status, clinical pregnancy rate, early miscarriage rate, and ongoing pregnancy rate were evaluated by univariate and multivariate regression.
UNASSIGNED: The euploidy rate of development speed D5 blastocysts was significantly greater than that of D6 blastocysts (61.4% vs. 38.1%, P < 0.001), and the euploid rate of morphologically high-grade blastocysts was significantly greater than that of non-high-grade blastocysts. Development speed D5 (OR = 1.6, 95% CI 1.2-2.2, P = 0.02) and high-grade morphology (OR = 2.1, 95% CI 1.5-2.9, P = 0.01) were independent predictors of euploidy. The ongoing pregnancy rate of D5 blastocysts was significantly higher than that of D6 blastocysts (62.3% vs. 43.8%, P = 0.04). Transfer of euploid blastocysts with high-grade morphology resulted in a greater ongoing pregnancy rate than transfer of non-high-grade euploid blastocysts (60.7% vs. 43.2%, P = 0.049). Alternatively, D6 development speed was an independent risk factor for early pregnancy loss after euploid blastocyst transfer. Multivariate regression analysis adjusting for confounding factors identified maternal age, blastocyst development speed, and blastocyst morphological grade as independent predictors of euploidy but not of clinical pregnancy.
UNASSIGNED: The recommended sequence of embryo transfer based on the present study is D5 high-grade > D6 high-grade > D5 non-high-grade > D6 non-high-grade.
Assisted reproductive technology physicians are actively exploring methods to improve the accuracy of embryo selection for successful pregnancy. We evaluated the associations of embryo morphological grade and development speed with chromosomal status and clinical outcome for couples without a history of infertility, in vitro fertilisation failure, or recurrent miscarriage receiving euploid embryo transfer. Blastocysts from females younger than 35 years, of high morphological grade, and demonstrating faster development speed were most likely to be euploid (least likely to have chromosomal abnormalities). Alternatively, patients implanted with slower developing euploid blastocysts were at higher risk of early pregnancy loss. To maximise the probability of implanting euploid embryos and minimise the risk of pregnancy loss, the selection order of embryo transferred should be based on embryo development speed followed by morphological grades.
UNASSIGNED: A total of 155 preimplantation genetic testing cycles including 959 blastocysts and 154 euploid blastocyst transfer cycles conducted between January 2018 and December 2019 were retrospectively analysed. The associations of blastocyst morphological quality and development speed (D) with chromosomal status, clinical pregnancy rate, early miscarriage rate, and ongoing pregnancy rate were evaluated by univariate and multivariate regression.
UNASSIGNED: The euploidy rate of development speed D5 blastocysts was significantly greater than that of D6 blastocysts (61.4% vs. 38.1%, P < 0.001), and the euploid rate of morphologically high-grade blastocysts was significantly greater than that of non-high-grade blastocysts. Development speed D5 (OR = 1.6, 95% CI 1.2-2.2, P = 0.02) and high-grade morphology (OR = 2.1, 95% CI 1.5-2.9, P = 0.01) were independent predictors of euploidy. The ongoing pregnancy rate of D5 blastocysts was significantly higher than that of D6 blastocysts (62.3% vs. 43.8%, P = 0.04). Transfer of euploid blastocysts with high-grade morphology resulted in a greater ongoing pregnancy rate than transfer of non-high-grade euploid blastocysts (60.7% vs. 43.2%, P = 0.049). Alternatively, D6 development speed was an independent risk factor for early pregnancy loss after euploid blastocyst transfer. Multivariate regression analysis adjusting for confounding factors identified maternal age, blastocyst development speed, and blastocyst morphological grade as independent predictors of euploidy but not of clinical pregnancy.
UNASSIGNED: The recommended sequence of embryo transfer based on the present study is D5 high-grade > D6 high-grade > D5 non-high-grade > D6 non-high-grade.
Assisted reproductive technology physicians are actively exploring methods to improve the accuracy of embryo selection for successful pregnancy. We evaluated the associations of embryo morphological grade and development speed with chromosomal status and clinical outcome for couples without a history of infertility, in vitro fertilisation failure, or recurrent miscarriage receiving euploid embryo transfer. Blastocysts from females younger than 35 years, of high morphological grade, and demonstrating faster development speed were most likely to be euploid (least likely to have chromosomal abnormalities). Alternatively, patients implanted with slower developing euploid blastocysts were at higher risk of early pregnancy loss. To maximise the probability of implanting euploid embryos and minimise the risk of pregnancy loss, the selection order of embryo transferred should be based on embryo development speed followed by morphological grades.
摘要：
■选择高质量的胚泡是决定辅助生殖技术成功的最重要因素。这项研究的目的是评估胚泡形态质量和发育速度对预测整倍体和临床妊娠结局的价值。
回顾性分析了在2018年1月至2019年12月期间进行的155个植入前遗传检测周期，包括959个囊胚和154个整倍体囊胚移植周期。囊胚形态质量和发育速度(D)与染色体状态的关系,临床妊娠率,早期流产率，和持续妊娠率通过单因素和多因素回归进行评估。
■发育速度D5囊胚的整倍体率显著大于D6囊胚(61.4%vs.38.1%,P<0.001)，形态高级胚泡的整倍体率明显高于非高级胚泡。发育速度D5（OR=1.6，95％CI1.2-2.2，P=0.02）和高级形态（OR=2.1，95％CI1.5-2.9，P=0.01）是整倍体的独立预测因素。D5囊胚的持续妊娠率明显高于D6囊胚(62.3%vs.43.8%,P=0.04)。具有高级形态的整倍体胚泡的移植比非高级整倍体胚泡的移植产生更大的持续妊娠率（60.7％vs.43.2%,P=0.049)。或者，D6发育速度是影响整倍体囊胚移植后早期妊娠丢失的独立危险因素。多因素回归分析调整混杂因素确定的产妇年龄，囊胚发育速度,和囊胚形态等级是整倍体的独立预测因子，但不是临床妊娠的独立预测因子。
■根据本研究，胚胎移植的推荐顺序为D5高级>D6高级>D5非高级>D6非高级。
辅助生殖技术医生正在积极探索提高成功妊娠胚胎选择准确性的方法。我们评估了没有不孕史的夫妇的胚胎形态等级和发育速度与染色体状态和临床结局的关系。体外受精失败，或接受整倍体胚胎移植的复发性流产。来自35岁以下女性的胚泡，形态等级高，并且表现出更快的发育速度最有可能是整倍体（最不可能有染色体异常）。或者，植入发育较慢的整倍体囊胚的患者早期妊娠丢失的风险较高.为了最大限度地提高整倍体胚胎植入的可能性，并最大限度地降低妊娠失败的风险，胚胎移植的选择顺序应根据胚胎发育速度和形态学等级。
回顾性分析了在2018年1月至2019年12月期间进行的155个植入前遗传检测周期，包括959个囊胚和154个整倍体囊胚移植周期。囊胚形态质量和发育速度(D)与染色体状态的关系,临床妊娠率,早期流产率，和持续妊娠率通过单因素和多因素回归进行评估。
■发育速度D5囊胚的整倍体率显著大于D6囊胚(61.4%vs.38.1%,P<0.001)，形态高级胚泡的整倍体率明显高于非高级胚泡。发育速度D5（OR=1.6，95％CI1.2-2.2，P=0.02）和高级形态（OR=2.1，95％CI1.5-2.9，P=0.01）是整倍体的独立预测因素。D5囊胚的持续妊娠率明显高于D6囊胚(62.3%vs.43.8%,P=0.04)。具有高级形态的整倍体胚泡的移植比非高级整倍体胚泡的移植产生更大的持续妊娠率（60.7％vs.43.2%,P=0.049)。或者，D6发育速度是影响整倍体囊胚移植后早期妊娠丢失的独立危险因素。多因素回归分析调整混杂因素确定的产妇年龄，囊胚发育速度,和囊胚形态等级是整倍体的独立预测因子，但不是临床妊娠的独立预测因子。
■根据本研究，胚胎移植的推荐顺序为D5高级>D6高级>D5非高级>D6非高级。
辅助生殖技术医生正在积极探索提高成功妊娠胚胎选择准确性的方法。我们评估了没有不孕史的夫妇的胚胎形态等级和发育速度与染色体状态和临床结局的关系。体外受精失败，或接受整倍体胚胎移植的复发性流产。来自35岁以下女性的胚泡，形态等级高，并且表现出更快的发育速度最有可能是整倍体（最不可能有染色体异常）。或者，植入发育较慢的整倍体囊胚的患者早期妊娠丢失的风险较高.为了最大限度地提高整倍体胚胎植入的可能性，并最大限度地降低妊娠失败的风险，胚胎移植的选择顺序应根据胚胎发育速度和形态学等级。
