【摘要】 目的探讨延时摄像系统(TLS)对胚胎发育及妊娠结局的影响。方法选择2016年12月至2017年12月,在江苏省苏北人民医院生殖医学中心接受体外受精/卵母细胞胞质内单精子注射-胚胎移植(IVF/ICSI-ET)的302例不孕症患者的319个周期为研究对象,将采用TLS培养胚胎的137个周期纳入TLS组,将采用传统培养箱培养胚胎的182个周期纳入对照组。其中,TLS组采用短时体外受精(IVF)的周期数为72个,采用卵母细胞胞质内单精子注射(ICSI)受精的周期数为16个,对照组分别为101个和23个。回顾性分析2组患者的一般临床资料、受精情况及妊娠结局等。采用Wilcoxon秩和检验,对2组患者窦卵泡数和获卵数等进行比较;采用χ~2检验或Fisher确切概率法,对2组患者优质胚胎率、囊胚形成率、优质囊胚率、生化妊娠率及临床妊娠率等进比较。本研究获得江苏省苏北人民医院伦理委员会审核批准(审批文号:2018KY-104)。结果 (1)2组患者的年龄、人体质量指数(BMI)、不孕年限、既往周期数、子宫内膜厚度、促排卵方案构成比、授精方式构成比、精子浓度、精子向前运动比例、促性腺激素(Gn)用量、基础雌二醇水平和基础促黄体激素(LH)水平等一般临床资料比较,差异均无统计学意义(P>0.05)。(2)TLS组患者窦卵泡数与获卵数分别为12.0个(9.5～15.0个)与10.0个(6.5～14.0个),显著高于对照组的10.0个(6.0～14.0个)和7.0个(4.0～11.3个),2组分别比较,差异均有统计学意义(Z=-3.751、-4.618,P<0.001)。(3)TLS组患者优质胚胎率、囊胚形成率、优质囊胚率分别为72.6%、74.7%和45.3%,分别高于对照组的67.5%、56.7%和36.8%,2组分别比较,差异均有统计学意义(χ~2=5.411、19.660、4.192,P=0.020、<0.001、=0.041)。(4)采用短时IVF时,TLS组患者优质胚胎率、囊胚形成率分别为74.5%和68.7%,分别高于对照组的69.6%和57.0%,2组比较,差异有统计学意义(χ~2=4.145、16.966,P=0.042、<0.001)。采用ICSI受精时,TLS组患者生化妊娠率和临床妊娠率分别为87.5%和87.5%,分别高于对照组的43.5%和43.5%,2组比较,差异均有统计学意义(χ~2=7.726、7.726,P=0.005、0.005)。结论采用TLS培养胚胎,可提高胚胎质量,改善受精方式为ICSI患者的妊娠结局。更多还原

【Abstract】 Objective To investigate effects of time-lapse system(TLS)on embryo development and pregnancy outcomes.Methods From December 2016 to December 2017,a total of 319 cycles from 302 infertile patients undergoing in vitrofertilization/intracytoplasmic sperm injectionembryo transfer(IVF/ICSI-ET)in the Reproductive Medical Center of Northern Jiangsu People′s Hospital were selected as research subjects.According to different embryo culture systems,137 cycles with embryos cultured by TLS were included in TLS group and 182 cycles with embryos cultured by traditional incubator were included in control group.In TLS group,the number of cycles with in vitro fertilization(IVF)short-term fertilization was 72,and the number of cycles with fertilization by intracytoplasmic sperm injection(ICSI)was 16,and the control group was 101 and 23,respectively.The general clinical data,fertilization conditions and pregnancy outcomes of two groups were analyzed retrospectively.The number of antral follicles and number of oocytes retrieved between two groups were compared by Wilcoxon rank sum test.The rates of high-quality embryos,blastocysts formation,high-quality blastocysts,biochemical pregnancy and clinical pregnancy between two groups were compared by chi-square test or Fisher′s exact test.This study was approved by the Ethics Committee of Northern Jiangsu People′s Hospital(Approval Number:2018 KY-104).Results(1)There were no significant differences in age,body mass index(BMI),infertility duration,number of previous cycles,endometrial thickness,constituent rate of ovarian stimulation methods and insemination methods,sperm concentration,proportion of sperm motion,the dosage of gonadotropins(Gn),basic estradiol and basic luteinizing hormone(LH)level between two groups(P>0.05).(2) The number of antral follicles and the number of oocytes retrieved in TLS group were 12.0(9.5-15.0)and 10.0(6.5-14.0),respectively,which were significantly higher than 10.0(6.0-14.0)and 7.0(4.0-11.3)in control group,and both the differences were statistically significant(Z=-3.751,-4.618;P<0.001).(3)The high-quality embryos rate,blastocysts formation rate and high-quality blastocysts rate of TLS group were 72.6%,74.7% and 45.3%,respectively,which were significantly higher than67.5%,56.7% and 36.8%in control group,respectively,and all the differences were statistically significant(χ~2=5.411,19.660,4.192;P=0.020,<0.001,=0.041).(4)In two groups of patients who received IVF short-term fertilization,the high-quality embryos rate and blastocysts formation rate of TLS group were 74.5% and 68.7%,respectively,which were significant higher than 69.6% and57.0% in control group,respectively,and both the differences were statistically significant(χ~2=4.145,16.966;P=0.042,<0.001).In two groups of patients who received ICSI fertilization,the biochemical pregnancy rate and clinical pregnancy rate of TLS group were 87.5% and 87.5%,respectively,which were significantly higher than 43.5% and 43.5%in control group,respectively,and both the differences were statistically significant(χ~2=7.726,7.726;P=0.005,0.005).Conclusions Using TLS to culture embryos can improve embryo quality and improve the pregnancy outcomes of infertile patients who received ICSI fertilization.更多还原