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目的应用时差成像(time-lapse imaging,TLI)技术监测胚胎发育过程,依据胚胎形态学结合时间参数及卵裂模式挑选优质胚胎移植,并与传统培养法比较,探讨时间参数及卵裂模式与胚胎发育潜能的关系。方法对2015年5月-2016年1月在该科室进行体外受精(in vitro fertilization,IVF)治疗的107例不孕患者的胚胎资料进行回顾性分析,A组(40例)行TLI动态观察,根据胚胎发育时间参数及卵裂模式D3选择胚胎移植;B组(67例)行传统培养,根据形态学标准挑选胚胎,移植后剩余胚胎继续培养至囊胚。结果两组受精率(76.54%vs 76.58%)、优质胚胎率(53.74%vs 48.81%)、临床妊娠率(60.00%vs 53.73%)、种植率(41.33%vs 34.92%)、多胎率(28.00%vs 16.67%)及流产率(8.00%vs 16.67%)比较,差异均无统计学意义(P>0.05)。A组种植胚胎与未种植胚胎两组相比,发育至2细胞的时间(t2)、从3细胞分裂到4细胞持续的时间(s2)、从2细胞分裂到3细胞持续的时间(cc2),差异均有统计学意义(P<0.05),发育至3、4、5细胞的时间(t3、t4、t5)比较,差异均无统计学意义(P>0.05)。对A组胚胎卵裂模式进行动态观察,正常卵裂胚胎组的优质囊胚形成率为50.47%,不均卵裂、碎片胚胎均有较高的囊胚形成率,分别为32.26%和37.50%,与正常卵裂胚胎组相比,差异均无统计学意义(P>0.05),多核、非二倍性卵裂、混合型组的胚胎优质囊胚形成率分别为12.50%、6.25%和10.81%,与正常卵裂胚胎组相比,差异均有统计学意义(P<0.05)。结论 TLI对胚胎进行非侵入性评估,为胚胎提供一个安全无干扰的发育环境;时间参数及卵裂模式有利于预测胚胎发育潜能,作为挑选胚胎的重要参数,选择优质胚胎移植。
OBJECTIVE: To monitor embryonic development by using time-lapse imaging (TLI) technique and to select high-quality embryo transfer according to embryo morphology combining time parameters and cleavage pattern. Compared with traditional culture method, time parameters and cleavage pattern and embryo Developmental potential of the relationship. Methods The data of embryos from 107 infertile patients who underwent in vitro fertilization (IVF) in this department from May 2015 to January 2016 were retrospectively analyzed. Group A (40 cases) underwent TLI dynamic observation, The embryo transfer was selected according to the parameters of embryonic development and cleavage pattern D3. Group B (67 cases) was selected and cultured according to morphological criteria. The remaining embryos were cultured to blastocyst after transplantation. Results The fertilization rate (76.54% vs 76.58%), high quality embryo rate (53.74% vs 48.81%), clinical pregnancy rate (60.00% vs 53.73%), implantation rate (41.33% vs 34.92% vs 16.67%) and miscarriage rate (8.00% vs 16.67%) respectively. There was no significant difference between the two groups (P> 0.05). The time to develop to 2 cells (t2), the time to divide from 3 cells to 4 cells (s2), the time to divide from 2 cells to 3 cells (cc2) , The differences were statistically significant (P <0.05), the development of 3,4,5 cells (t3, t4, t5), the difference was not statistically significant (P> 0.05). The cleavage patterns of group A embryos were observed dynamically. The rate of blastocyst formation in normal cleavage embryos was 50.47%, and the rate of blastocyst formation was 32.26% and 37.50% (P> 0.05). The blastocyst formation rates of embryos in multi-nuclear, non-diploid cleavage and mixed groups were 12.50%, 6.25% and 10.81 %, Compared with the normal cleavage embryos group, the difference was statistically significant (P <0.05). Conclusion TLI provides noninvasive evaluation of embryos and provides a safe and interference-free environment for embryo development. Time parameters and cleavage patterns are useful for predicting embryonic development potential. As an important parameter for embryo selection, TLI is a good choice for embryo transfer.