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Objective

目的

Extended blastocyst culture and embryo transfer (ET) has proven to result in higher pregnancy (PR) and live birth (LBR) rate compared to cleavage stage transfer. While this is thought to be due to greater oocyte yield, optimal embryo selection and improved embryo-endometrium synchrony, limited data exists on the benefits of blastocyst culture in advanced maternal age (AMA) (>40 years) women whose embryos may be less likely to resist prolonged in vitro conditions. We compared pregnancy outcomes of those undergoing d-3 vs d-5 ET in AMA women and secondarily analyzed those who had a d-3 ET, but otherwise met criteria for extended culture (3 or more good morphology embryos on day 3) to those undergoing d-5 ET.

与卵裂期胚胎移植相比，囊胚培养和移植（ET）具有更高的妊娠率（PR）和活产率（LBR），这可能和获卵多、最佳的胚胎选择和胚胎-子宫内膜同步性提高有关，然而关于高龄女性（AMA）行囊胚培养益处的研究有限，而高龄女性的胚胎可能对体外延长培养环境的抵抗力差。本研究中我们首要分析了高龄女性行D3和D5胚胎移植的妊娠结局，其次比较了那些虽然移植了D3胚胎，但是其胚胎符合囊胚培养标准（第3天有3个或更多形态良好的胚胎）与D5囊胚移植的高龄女性的妊娠结局。

Materials and Methods

材料与方法

All fresh IVF-ICSI cycles performed from Jan 2020 to Dec 2021 in AMA women that progressed to ET were considered for analysis. Baseline demographic, cycle stimulation characteristics, embryology and pregnancy outcomes were collected and analyzed using t-test, chi square test and ANOVA analysis as appropriate.

对2020年1月至2021年12月期间行IVF-ICSI鲜胚移植的所有高龄女性进行分析。收集基线人口统计学、周期特征、胚胎学和妊娠结局，并使用t检验、卡方检验和方差分析进行统计。

Results

结果

In the study period, 824 cycles were initiated; 168 cycles were excluded for cancellation during stimulation, retrieval, fertilization failure, embryonic arrest or elective cryopreservation. Compared to d-5 (n=184), those patients undergoing d-3 ET (n=472), were older (41.9 ± 1.4 (SD) vs 41.4 ± 1.3 yrs, p<0.01), had lower ovarian reserve (AMH: 1.4 ± 2.6 vs 2.0 ± 1.6 ng/mL, p=0.01), had fewer oocytes retrieved (4.4 ± 2.9 vs 8.8 ± 4.2, p<0.001) and had lower number of ET (1.6 ± 0.5 vs 1.8 ± 0.5, p<0.001). Significantly lower PR (15.8% [74] vs 31.5% [58], p<0.001) and ongoing (OG)-PR (10.5% [50] vs 24.4% [45], p<0.001) were in d-3 compared to d-5 ET group. In those undergoing d-3 ET, but who met criteria for extended culture (n=135), age (41.8 ± 1.4 vs 41.4 ± 1.3 yrs); AMH (2.0 ± 1.9 vs 2.0 ± 1.6 ng/mL); number of retrieved oocytes (8.8 ± 4.2 vs 8.8 ± 4.2); and PR (25.1% [74] vs 31.5% [58]) were comparable to the d-5 group. However, OG-PR was significantly lower (13.3% [18] vs 24.4% [45], p=0.01) and miscarriage rates higher (47% [16] vs 22.4% [ 13], p=0.01).

在研究期间，纳入了824个周期，其中168个周期因为促排取消周期、未获卵或受精失败、胚胎发育阻滞以及选择冷冻胚胎而被排除。与D5移植（n=184）相比，行D3移植(n=472)的患者年龄更大(41.9±1.4 (SD) vs 41.4±1.3 yrs, p<0.01)，卵巢储备更低 (AMH: 1.4±2.6 vs 2.0±1.6 ng/mL, p<0.01)，获卵数更少 (4.4±2.9 vs 8.8±4.2, p<0.001) ，移植胚胎数更少(1.6 ±0.5 vs 1.8 ±0.5, p<0.001)。D3移植组的妊娠率(15.8%[74] vs 31.5%[58], p<0.001) 和持续妊娠率 (10.5%[50] vs 24.4%[45], p<0.001) 均显著低于D5移植组。行D3移植然而其胚胎符合囊胚培养标准的患者，其年龄 (41.8±1.4 vs 41.4±1.3 yrs)、AMH (2.0±1.9 vs 2.0±1.6 ng/mL)、获卵数 (8.8±4.2 vs 8.8±4.2)和妊娠率 (25.1%[74] vs 31.5% [58]) 均与D5移植组相当。但是，与D5移植组相比，D3移植且其胚胎符合囊胚培养组的持续妊娠率显著降低(13.3%[18] vs 24.4%[45], p<0.01)、流产率显著提高(47%[16] vs 22.4%[13], p<0.01)。

Conclusions

结论

Blastocyst culture provides a significant benefit to AMA patients who meet criteria for extended culture, resulting in higher OG-PR and lower pregnancy loss compared to cleavage stage ET. While concerns regarding extended culture may result in higher cycle cancellation, the psychological burden of pregnancy loss and delays in treatment can be avoided.

胚胎评估后符合囊胚培养标准的高龄女性，行囊胚培养和移植会显著益处。然而要考虑到，延长至囊胚培养可能会导致更高的周期取消，流产和延误治疗带来的心理负担。

Impact Statement

影响声明

In advanced maternal age women, those meeting criteria for blastocyst embryo culture have higher ongoing pregnancy rates and reduced pregnancy loss.

符合囊胚培养标准的高龄妇女，行囊胚移植持续妊娠率更高，流产率降低。

文章来源：

IS THERE AN ADDED BENEFIT WITH EXTENDED EMBRYO CULTURE IN WOMEN OF ADVANCED MATERNAL AGE UNDERGOING IVF-ET?Kovacs, Peter et al.Fertility and Sterility, Volume 118, Issue 4, e267 - e268