目的:双细胞期的细胞核状态如何预测单个囊胚移植后的囊胚形成和临床结局?
结论:双细胞期(2BI)的双核胚胎显示出更高的高质量囊胚形成率,与每个卵裂球有一个核的人相比,怀孕和活产(2MONO),而与2MONO胚胎相比,双细胞阶段(2MULTI)的真正多核胚胎显示出较低的高质量胚泡形成和妊娠率。
背景:延时培养的引入使更一致地研究双细胞阶段的细胞核状态成为可能,并且表明双细胞阶段(2MN)的多核化是常见事件。2MN的作用尚不清楚。据报道,大量的2MN有可能发展成胚泡,成为临床妊娠并导致健康婴儿的出生,而围产期结局没有受损。然而,一些研究发现2MN与植入受损和活产相关.此外,关于多核的不同亚组如何影响IVF结局的知识有限.
UNASSIGNED:在一家公共生育诊所进行了一项非干预性回顾性研究。该研究使用了2016年5月至2018年12月期间参加第一个IVF周期的223名女性的囊胚形成数据,以及2014年5月至2018年12月期间1314例单囊胚移植的临床结果数据。包括新鲜和冻融的胚胎移植。
方法:胚胎在延时培养箱中培养至胚泡期,细胞核处于双细胞期,对Gardner评分和其他形态动力学参数进行了注释。我们比较了胚泡发育和临床结果,包括阳性的hCG,持续怀孕和活产,具有2BI和/或2MULTI卵裂球至2MONO胚胎的胚胎。
结果:与2MONO胚胎相比,在一个卵裂球(2BI1)中具有2BI的胚胎发育为高质量胚泡的可能性是2倍(优势比(OR)2.54,95%CI1.30-4.95,P=0.006)。与2MONO胚胎相比,两个卵裂球(2MULTI2)中具有2MULTI的胚胎发育成高质量胚泡的能力明显较低(OR0.38,95%CI0.23-0.63,P<0.001)。在两个卵裂球(2BI2)中具有2BI的胚胎具有显着更好的机会导致hCG阳性(OR2.40,95%CI1.11-5.20,P=0.027),与单个囊胚移植后的2MONO囊胚相比,持续妊娠(OR2.79,95%CI1.29-6.04,P=0.009)和活产(OR3.16,95%CI1.43-6.95,P=0.004)。相比之下,与2MONO囊胚相比,2MULTI2胚胎导致hCG阳性(OR0.58,95%CI0.35-0.97,P=0.036)和持续妊娠(OR0.51,95%CI0.28-0.94,P=0.030)的可能性显着降低。
结论:现有研究中关于多核化定义的差异可能导致不同的结论。尽管在我们的研究设计中,双核和真正的多核化之间的区别是一种优势,真正的多核胚胎和微核胚胎之间的进一步区分可能会在未来的研究中进行研究。此外,我们将任何无核胚胎纳入2MONO组.为了研究临床结果,这些患者被允许纳入一个以上的转移周期.包括新鲜和解冻的转移。
结论:我们发现在评估双细胞阶段的胚胎细胞核状态时,区分二核和真多核是很重要的。显示2BI1和2BI2的胚胎在单囊胚移植后具有明显更好的良好质量囊胚形成率和临床结局,分别。2MULTI2胚胎具有受损的胚泡发育潜能和较差的临床结果。
背景:H.S.N.从默克公司获得了3个月的不受限制的补助金,这是医生(A.L.T.)撰写手稿的正常薪水。默克公司没有参与研究设计,分析,数据解释,撰写论文或决定投稿发表。H.S.N.已经从Ferring制药公司收到了演讲者的费用,默克丹麦A/S,AstraZeneca,CookMedical和IbsaNordic(在提交的工作之外)。N.l.C.F.已收到GedeonRichter的资助(在提交的作品之外)。其他作者没有报告任何潜在的利益冲突。所有作者都声明对这项工作没有利益冲突。
背景:不适用。
OBJECTIVE: How does nucleus status at the two-cell stage predict blastocysts formation and clinical outcome after single blastocyst transfer?
CONCLUSIONS: Binucleated embryos at the two-cell stage (2BI) show higher rates of good quality blastocyst formation, pregnancy and live birth compared to those with one nucleus in each blastomere (2MONO), whereas true multinucleated embryos at the two-cell stage (2MULTI) show lower rates of good quality blastocyst formation and pregnancy compared to 2MONO embryos.
BACKGROUND: The introduction of time-lapse culture has made it possible to study nucleus status at the two-cell stage more consistently and it shows that multinucleation at the two-cell stage (2MN) is a common event. The effect of 2MN is still unclear. High numbers of 2MN with the potential to develop to blastocysts that become clinical pregnancies and result in birth of healthy babies with no impaired perinatal outcome have been reported. However, some studies have found 2MN to be associated with impaired implantation and live birth. Furthermore, knowledge on how the different subgroups of multinucleation affects the IVF outcome is limited.
UNASSIGNED: A non-interventional retrospective study was performed in a public fertility clinic. Blastocyst formation data from 223 women attending their first IVF cycle between May 2016 and December 2018, and clinical outcome data from 1314 single blastocyst transfers between May 2014 and December 2018 were used for the study. Fresh and frozen-thawed embryo transfers were included.
METHODS: Embryos were cultured until the blastocyst stage in a time-lapse incubator and nucleus status at the two-cell stage, the Gardner score and other morphokinetic parameters were annotated. We compared blastocyst development and clinical outcome, including positive hCG, ongoing pregnancy and live birth, of embryos with 2BI and/or 2MULTI blastomeres to 2MONO embryos.
RESULTS: Embryos with 2BI in one blastomere (2BI1) were twice as likely to develop to good quality blastocysts (odds ratio (OR) 2.54, 95% CI 1.30-4.95, P = 0.006) compared to 2MONO embryos. Embryos with 2MULTI in both blastomeres (2MULTI2) were significantly less able to develop to good quality blastocysts (OR 0.38, 95% CI 0.23-0.63, P < 0.001) compared to 2MONO embryos. Embryos with 2BI in both blastomeres (2BI2) had a significantly better chance of resulting in a positive hCG (OR 2.40, 95% CI 1.11-5.20, P = 0.027), ongoing pregnancy (OR 2.79, 95% CI 1.29-6.04, P = 0.009) and live birth (OR 3.16, 95% CI 1.43-6.95, P = 0.004) compared to 2MONO blastocysts after single blastocyst transfer. In contrast, 2MULTI2 embryos were significantly less likely to result in a positive hCG (OR 0.58, 95% CI 0.35-0.97, P = 0.036) and ongoing pregnancy (OR 0.51, 95% CI 0.28-0.94, P = 0.030) compared to 2MONO blastocysts.
CONCLUSIONS: Discrepancies among the existing studies regarding the definition of multinucleation may lead to different conclusions. Even though the distinction between binucleation and true multinucleation was a strength in our study design, a further distinction between true multinucleated and micronucleated embryos could be interesting to investigate in future studies. Also, we included any anucleated embryos in the 2MONO group. For the study of clinical outcomes, the patients were allowed to be included with more than one transfer cycle. Both fresh and thawed transfers were included.
CONCLUSIONS: We find it important to discriminate between binucleation and true multinucleation when evaluating embryo nucleus status at the two-cell stage. Embryos displaying 2BI1 and 2BI2 have significantly better good quality blastocyst formation rates and clinical outcome after single blastocyst transfers, respectively. 2MULTI2 embryos have impaired blastocyst development potential and poorer clinical outcomes.
BACKGROUND: H.S.N. received an unrestricted grant from Merck for 3 months\' normal salary for a medical Doctor (A.L.T.) to write the manuscript. Merck was not involved in the study design, analysis, interpretation of data, writing the paper or the decision to submit the manuscript for publication. H.S.N. has received speaker\'s fees from Ferring Pharmaceuticals, Merck Denmark A/S, Astra Zeneca, Cook Medical and Ibsa Nordic (outside the submitted work). N.l.C.F. has received a grant from Gedeon Richter (outside the submitted work). The other authors did not report any potential conflicts of interest. All authors declared no conflicts of interest regarding this work.
BACKGROUND: N/A.