IVF/ICSI-ET中胚胎实时监测系统与常规形态学评估选择性单胚胎移植累积活产率分析

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中文摘要：目的:分析胚胎实时监测(TLM)系统和常规形态学评估(CMA)在体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)中选择性单胚胎移植的临床应用价值，并初步探讨拉曼光谱分析胚胎培养液对临床妊娠率的预测价值。方法:本研究为前瞻性随机对照临床研究，选择2019年4月至2020年7月在苏州市立医院生殖与遗传中心行IVF/ICSI-ET助孕的139例患者，随机分为TLM组和CMA组，分别选择最优胚胎行单胚胎移植(新鲜周期和复苏周期)，患者第1次胚胎移植未获临床妊娠，则进行第2次，比较两组患者移植后的累积活产率和其他妊娠结局差异。同时收集IVF/ISCI受精后第3天胚胎培养液15 μl，进行拉曼光谱分析。结果:TLM组与CMA组的累积活产率、累积临床妊娠率、累积早产率、累积早期自然流产率、累积异位妊娠率、累积早产率、小于胎龄儿或大于胎龄儿差异均无统计学意义(P＞0。05)。TLM组新生儿性别比低于CMA组，但差异无统计学意义(P＞0。05)。胚胎培养液拉曼光谱分析预测临床妊娠率的准确度为67。21％。结论:在卵巢储备功能良好的年轻女性中，进行选择性单胚胎移植时TLM评估胚胎优势不明显，需警惕基于动力学参数的胚胎选择可能影响性别比。拉曼光谱分析胚胎培养液尚不能很好地预测胚胎的种植能力。

外文标题：Analysis of Cumulative Live Birth Rate of Selective Single Embryo Transfer by Time-lapse Monitoring System and Conventional Morphological Assessment in IVF/ICSI-ET

外文摘要：Objective:To analyse the clinical significance of selective single embryo transfer by time-lapse mo-nitoring(TLM)or conventional morphology assessment(CMA)in vitro fertilization/intracytoplasmic sperm in-jection and embryo transfer(IVF/ICSI-ET),and to initially explore the predictive value of Raman spectral analy-sis of embryo culture medium for clinical pregnancy rate.Methods:The study is a prospective randomized con-trolled clinical trial.We assigned 139 patients treated with IVF/ICSI-ET in Reproductive and Genetics Center of Suzhou Municipal Hospital from April 2019 to July 2020,which were randomly assigned to either the CMA or the TLM group.We performed selective single-embryo transfer(fresh cycle and FET)after selecting the optimal em-bryos with TLM or CMA respectively.If the patient's first embryo transfer was unsuccessful,a second one would be performed to compare the differences in the cumulative live birth rate of embryo transfer and other pregnancy outcomes between the two groups.Meanwhile,we collected 15 μl of embryo culture medium at day 3 after IVF/ISCI fertilization for Raman spectroscopy analysis.Results:There were no differences in cumulative live birth,cu-mulative clinical pregnancy,cumulative premature birth,cumulative early spontaneous abortion,cumulative ectopic pregnancy and LGA or SGA between TLM and CMA groups(P＞0.05).The Neonatal sex ratio in the TLM group was lower than that in the CMA group,but the difference was not significant(P＞0.05).Raman spectros-copy analysis of embryo culture medium predicted the clinical pregnancy rate with 67.21％accuracy.Conclu-sions:In young women with a good ovarian reserve,the advantage of using TLM to evaluate embryos is not obvi-ous,so we should remain vigilant that embryo selection based on morphokinetic parameters may affect the sex ratio.Raman spectroscopic analysis of embryo culture medium is not yet able to effectively predict the planting ability of embryos.

外文关键词：

In vitro fertilization/intracytoplasmic sperm injection and embryo transferTime-lapse monitoringConventional morphology assessmentRaman spectral analysisCumulative live birth rate

作者：

成桂红、郑爱燕、丁洁、邹琴燕、许咏乐、朱蕊、王馥新、吴惠华、李红、孟庆霞

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作者单位：

南京医科大学附属苏州医院苏州市立医院生殖与遗传中心,江苏苏州 215002

关键词：

体外受精/卵胞浆内单精子注射-胚胎移植胚胎实时监测常规形态学拉曼光谱分析累积活产率

基金：

国家重点研发计划苏州市卫健委临床重点病种项目

项目编号：

2022YFC2702901LCZX202109

出版年：

2024

实用妇产科杂志

四川省医学会

实用妇产科杂志

CSTPCD北大核心

影响因子：2.564

ISSN：1003-6946

年,卷(期)：2024.40(2)

参考文献量29