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目的:探讨D2胚胎的各种形态特征对D3胚胎质量、D6囊胚发育和胚胎着床潜能的影响,以评估D2形态在体外受精-胚胎移植(IVF-ET)中的临床应用价值。方法:于常规IVF或ICSI授精后42～44 h观察D2胚胎形态特征,按D2细胞数、碎片比例、卵裂球大小均匀程度和卵裂球内的核特征进行分组,比较各组间的D3优质胚胎率、D6囊胚形成率和着床率。按卵裂球内的核特征分组,将胚胎分为A级(胚胎的每个卵裂球内均可见单核)、B级(胚胎至少有1个卵裂球内未见核)、C级(胚胎每个卵裂球均未见核)和D级〔胚胎至少有1个卵裂球内见多核(≥2个核)〕。结果:①4细胞胚胎的体外发育能力和体内着床潜能优于另外两组,>4细胞胚胎的D3优质胚胎率和着床率高于<4细胞胚胎。②碎片≤10%的D2胚胎的体外发育能力和体内着床潜能优于碎片>10%的胚胎。③与其他各组相比,A组具有最高的体外发育能力和着床潜能,在形态优质的D2胚胎中,也得到同样的结果。而D组胚胎中,D3优质胚胎率明显低于其他各组,而且在移植的27个D组胚胎中,没有胚胎着床。结论:碎片≤10%的4细胞胚胎具有较高的体外发育能力和体内着床潜能;同时,D2核评估可独立预测胚胎体内外发育能力,选择时应优先考虑每个卵裂球上均可见单核的胚胎;胚胎中多核的存在是发育潜能受损的表现。
Objective: To investigate the effect of morphological characteristics of D2 embryos on D3 embryo quality, D6 blastocyst development and embryo implantation potential in order to evaluate the clinical value of D2 morphology in IVF-ET (IVF-ET). Methods: Morphological characteristics of D2 embryos were observed 42 ~ 44 h after routine IVF or ICSI insemination and were divided into groups according to the number of D2 cells, fragment ratio, the size of blastomeres and the nuclear features in blastomeres. High quality embryo rate, D6 blastocyst formation rate and implantation rate. According to the nuclear characteristics of the blastomere grouping, the embryos were divided into A grade (embryos can be seen in each blastomere mononuclear), B (embryos at least one blastomere no nuclear), C (No blastocyst in each blastomere) and Grade D (at least one blastomere in the embryo has multiple nuclei (≥2 nuclei)]. Results: ① The in vitro developmental ability and in vivo implantation potential of 4-cell embryos were better than those of the other two groups. The high-quality embryo and implantation rate of> 4-cell embryos were higher than that of <4-cell embryos. ② The in vitro development ability and in vivo implantation potential of D2 embryos with fragmentation less than 10% were better than that of embryos with> 10% fragmentation. ③ Compared with other groups, group A had the highest in vitro developmental ability and implantation potential, and the same result was obtained in morphologically good D2 embryos. However, in group D embryos, the rate of high quality D3 embryos was significantly lower than that in other groups, and no embryo implantation was found in 27 D embryos transplanted. CONCLUSION: The 4-cell embryos with fragmentation less than 10% have higher in vitro development ability and in vivo implantation potential. Meanwhile, D2 nuclear assessment can independently predict the in vitro and in vivo developmental capacity of embryos, and should be prioritized for each blastomere Mononuclear embryos; the presence of multiple nuclei in an embryo is a manifestation of impaired developmental potential.