不同精子来源及授精方式对剩余胚胎继续囊胚培养结局的影响

目的:探讨不同精子来源及不同授精方式对胚胎继续发育能力的影响。方法:分析499例患者499个取卵周期剩余胚胎继续培养形成囊胚的情况,按精子来源不同分为供精IVF(D-IVF)组和夫精IVF(H-IVF)组,按授精方式不同分为IVF组和ICSI组,ICSI组按精子来源分为新鲜精液组、附睾精子和睾丸精子组,比较不同精子来源及授精方式获得剩余胚胎的囊胚形成率、胚胎利用率和无囊胚移植率。结果:① D-IVF组和H-IVF组受精率、卵裂率、优质胚胎率、第3日和第5日胚胎种植率、临床妊娠率和流产率均无统计学差异(P0.05),组间剩余胚胎囊胚形成率、胚胎利用率和无囊胚移植率亦无统计学差异(P0.05);②ICSI组与IVF组比较,其受精率较高(P0.05),但优质胚胎率显著下降,有统计学差异(55.11%vs 61.30%,P0.05),组间第3日卵裂期胚胎和剩余胚胎囊胚种植率、临床妊娠率无统计学差异(P0.05),但ICSI组与IVF组比较,其剩余胚胎囊胚形成率、胚胎利用率稍低,无囊胚移植率较IVF组稍高,差异有统计学意义(56.13%vs 65.32%,48.18%vs 55.39%,21.68%vs 13.20%,P0.05)。③新鲜精液组的优质胚胎率、胚胎利用率显著低于附睾精子和睾丸精子组(P0.05),各组囊胚移植的种植率和临床妊娠率无统计学差异(P0.05)。结论:D-IVF可获得H-IVF相似的结局,其剩余胚胎都有较高的发育潜能,ICSI获得的剩余胚胎发育潜能低于IVF组。附睾精子和睾丸精子ICSI后获得的胚胎比新鲜精液精子ICSI后胚胎发育潜能高。针对不同的授精方式可能需要制定相应的剩余胚胎囊胚培养标准。     

影响冻融胚胎发育潜能及妊娠结局因素的探讨

目的:探讨胚胎冷冻复苏后,卵裂球存活状态对胚胎发育的影响以及体外授精(IVF)和卵胞质内单精子注射(ICSI)2种授精方式对冷冻胚胎复苏后体外发育能力和妊娠结局的影响。方法:回顾性分析142例患者,150个复苏周期,共769个冷冻胚胎复苏后培养至囊胚期进行移植的结果。结果:共复苏胚胎769个,存活胚胎702个,复苏率91.3%。220个胚胎(31%)到达囊胚阶段。在卵裂球全部存活胚胎中,囊胚形成率35%,部分存活胚胎中囊胚形成率24%,两者有统计学差异(P<0.01)。在卵裂球全部存活胚胎中,来源于IVF的胚胎囊胚形成率为40%,来源于ICSI的为26%,两者有统计学差异(P<0.01);部分卵裂球存活胚胎中来源于IVF的胚胎囊胚形成率为26%,来源于ICSI的为19%,差异无统计学意义(P>0.05)。在全部220个囊胚中,IVF组的优质囊胚率为38.6%,ICSI组的优质囊胚率为21.0%,差异有统计学意义(P<0.05)。临床妊娠率IVF组和ICSI组分别为61.05%与61.11%;胚胎种植率分别为37.50%与36.67%,活产率分别为81.03%与78.79%,差异均无统计学意义(P>0.05)。结论:胚胎冷冻复苏后卵裂球的损伤削弱了囊胚形成能力,影响卵裂期胚胎进一步发育,这与ICSI和冷冻胚胎复苏后发育潜能的降低有关,但其对临床结果和妊娠结局的影响不大。     

原核分级对胚胎质量及妊娠结局的影响

目的 探讨原核分级对胚胎质量及妊娠结局的影响.方法 回顾性分析2006年3月至7月在沈阳东方医疗集团菁华医院治疗的95例患者,95个治疗周期:59例体外受精(IVF)周期,34例卵胞浆内单精子显微注射(ICSI)周期,2例IVF+ICSI周期.在IVF或ICSI后17～19h观察受精情况,将正常受精的合子分为两组:正常发育的O型(OA/OB)合子和非正常发育的P型(P1,P2,P3,P4,P5)合子.每个合子均单独培养,追踪胚胎质量,取卵后3d进行胚胎移植.结果 95例患者平均妊娠率为34.74%(33/95),平均种植率为18.46%(43/233).O型合子的卵裂率、优质胚胎率分别为(98.70±6.92)%、(45.35±39.49)%;P型合子的卵裂率、优质胚胎率分别为(98.74±6.00)%、(47.52±32.30)%,两组间卵裂率和优质胚胎率均无统计学意义(P＞0.05).移植3组(O型合子、P型合子、0+P型合子)的妊娠率分别为27.27%、30.77%、37.93%;种植率分别为16.00%、14.75%、20.41%,3组间妊娠率和种植率均无统计学意义(P＞0.05).结论 在设定的合子分级中,认为正常发育的O型合子和非正常发育的P型合子,他们在胚胎质量、临床妊娠率和种植率等方面无明显差异.     

IVF和ICSI中多原核受精卵的发育及遗传多态性分析

目的:了解IVF和ICSI治疗周期中多原核受精卵的发育情况及其基因座遗传多态性。方法:分别收集IVF和ICSI治疗中的废弃多原核(≥3PN)受精卵315个和67个,进行体外培养,观察比较其发育能力,并复合扩增多原核来源的1株胚胎干细胞和2个囊胚细胞DNA的15个短串联重复序列(STR)基因座,利用3100遗传分析仪对其进行STR基因座多态性检测。结果:IVF组和ICSI组的多原核受精卵卵裂率无显著性差异(P>0.05),但IVF组胚胎停育率和囊胚形成率显著低于ICSI组(P<0.01)。STR基因座多态性检测显示,IVF组3PN受精卵来源的胚胎干细胞为典型的三倍体特征,但ICSI组4PN受精卵来源的2个囊胚未表现多倍体特征。结论:多原核受精卵有继续发育能力,其中IVF组多原核来源胚胎干细胞表现遗传物质倍性改变,而ICSI组多原核来源囊胚无遗传物质倍性变化。     

异常受精胚胎临床利用价值探讨

目的:探讨常规体外受精(IVF)和卵胞浆内单精子注射(ICSI)周期中异常受精胚胎的临床利用价值。方法:回顾性分析2013年4月至2015年6月在白求恩国际和平医院生殖中心接受体外受精-胚胎移植(IVF-ET)治疗(包括常规IVF和ICSI)的955个周期的实验室和临床数据。结果:ICSI周期双原核(2 PN)受精率显著高于IVF周期2 PN受精率(88.20%vs 72.04%,P0.01),而ICSI周期的未见原核(0 PN)、单原核(1 PN)及多原核受精率均低于IVF周期(P0.01),差异有统计学意义。第5天(D5)0 PN的囊胚形成率和可利用囊胚率显著高于2 PN和1 PN组(P0.01)。新鲜移植周期和冻融卵裂胚移植周期,0 PN组种植率和临床妊娠率显著低于2 PN组(P0.01),但是冻融囊胚移植周期,0 PN组的种植率和临床妊娠率与2 PN组相比,差异均无统计学意义(P0.05)。结论:IVF/ICSI周期中没有2 PN胚胎可供选择移植时,可选择0 PN胚胎,囊胚培养是合理利用异常受精胚胎的有效手段。     

非优质胚胎囊胚培养应用价值研究

目的探讨非优质胚胎囊胚培养是否为高效利用非优质胚胎的最佳选择,为制定更利于患者的助孕方案提供参考。方法选择2015年12月至2016年12月在中国医科大学附属盛京医院辅助生殖中心接受体外受精-胚胎移植(IVF-ET)或卵胞浆内单精子显微注射-胚胎移植(ICSI-ET)的不孕患者308例。第3天无优质胚胎形成,按患者意愿分为两组:卵裂期移植组(196例)及囊胚培养组(112例)。比较两组累积临床妊娠率、种植率、流产率、治疗成本、移植周期。结果卵裂期移植组与囊胚培养组的种植率(26.4%vs.44.3%)、周期数[每例患者(1.12±0.37)个vs.(0.86±0.45)个]、治疗成本[每例患者(4433.67±2027.10)元vs.(4750.97±2067.06)元]比较,差异均有统计学意义(P0.05)。累积临床妊娠率(49.5%vs.44.6%)、流产率(4.1%vs.2.0%)比较,差异均无统计学意义(P0.05)。囊胚培养组具有较高的周期取消率。卵裂期移植组第3天胚胎数≥5枚的累积临床妊娠率显著高于囊胚培养组(81.6%vs.53.6%),差异有统计学意义(P0.05)。结论囊胚培养并不是高效利用非优质胚胎的最佳选择;卵裂期胚胎形态学评估预测胚胎植入潜能作用有限。     

血脂水平与体外受精周期胚胎质量的相关性初步研究

目的:研究不孕症患者血脂水平与体外受精(IVF/ICSI)胚胎质量的相关性。方法:对行IVF/ICSI治疗、符合纳入标准的646例不孕症患者的资料进行回顾性分析,测定、分析血清三酰甘油(TG)、总胆固醇(TC)、高密度脂蛋白(HDL)、非高密度脂蛋白(nonHDL)、低密度脂蛋白(LDL)和脂蛋白(a)[LP(a)]水平与胚胎质量的关系。血脂水平和IVF/ICSI胚胎质量相关性采用Spearman相关分析。结果:患者年龄、体质量指数(BMI)、基础FSH、窦卵泡数、Gn用量及血脂水平临床妊娠组和非临床妊娠组之间均无统计学差异;受精率、卵裂数、优质胚胎数和优质胚胎率临床妊娠组均显著高于未临床妊娠组(P<0.05)。血脂水平和IVF/ICSI胚胎质量相关分析显示:TG和TC与卵子数、受精数及卵裂数均显著负相关,TC、LDL及nonHDL与优质胚胎数呈显著负相关(P<0.05),其余均无统计学意义。结论:血脂水平临床妊娠组与未临床妊娠组间均无统计学差异;IVF/ICSI胚胎质量与TC、LDL及nonHDL呈显著负相关。     

囊胚期与卵裂期胚胎培养及移植60例疗效比较

目的比较囊胚期与卵裂期胚胎培养及移植的疗效。方法2002年9月至2003年2月,中国医科大学第二医院采用序贯培养的方法,对30例(囊胚组)IVFET的患者进行囊胚培养及移植,并与30例(卵裂组)在胚胎卵裂期移植的IVFET患者作配对研究。囊胚组移植胚胎1～2枚,对照组移植胚胎3枚。比较两组的胚胎种植率、临床妊娠率及多胎妊娠率。结果囊胚组的胚胎种植率高于卵裂组(56.76%、17.78%),差异有显著性意义(χ2=9.44,P<0.05)。囊胚组的临床妊娠率高于卵裂组(59.29%、26.70%),差异有显著性意义(χ2=4.37,P<0.05)。囊胚组与卵裂组多胎妊娠率分别为31.25%、62.50%。结论囊胚期胚胎培养及移植的疗效优于卵裂期。     

早期补救ICSI应用价值的初步探讨

目的:探讨早期补救ICSI的应用价值。方法:回顾性分析IVF受精失败、取卵后20h行补救ICSI者19例(晚补救ICSI,A组)及加精子(IVF)4~6h后未见第二极体(Pb2)的成熟卵行补救ICSI者31例(早补救ICSI,B组),并与544例同期常规ICSI(C组)进行比较,观察受精率、卵裂率、有效胚胎率、优质胚胎率、胚胎种植率、临床妊娠率,评价早补救ICSI有效性。结果:3组年龄及基础FSH均无统计学差异,B组正常受精率显著高于A组,但显著低于C组(71.27%vs55.69%vs81.08%,P<0.05),>2原核(PN)率A、B组间无统计学差异,但显著高于C组(7.73%vs7.78%vs2.73%,P<0.01),卵裂率B组显著高于A组(100%vs94.62%,P<0.05),有效胚胎率3组间无统计学差异,优质胚胎率B组显著高于A组,但低于C组(51.16%vs22.73%vs60.19%,P<0.01),胚胎种植率B组显著高于A组(1.75%vs17.54,P<0.05),与C组比较无统计学差异(17.54%vs18.90%,P>0.05),3组临床妊娠率分别为5.26%,26.67%和34.57%,与C组比,A组临床妊娠率显著下降(P<0.01)。结论:与晚补救ICSI相比,早补救ICSI获得了更高的受精率、卵裂率、优质胚胎率及种植率,但多PN率高于常规ICSI,优质胚胎率仍低于常规ICSI。     

囊胚培养与囊胚移植的临床应用

目的:探讨囊胚培养与囊胚移植在临床上的应用价值。方法:将卵裂期胚胎延长体外培养至囊胚期,观察囊胚形成率及质量,分析卵裂期胚胎质量与囊胚形成的关系及囊胚形成与临床妊娠的关系。结果:387例患者3 513个胚胎进行囊胚培养,共获得1 489个囊胚,囊胚形成率为42.35%。Ⅰ￣Ⅱ级胚胎囊胚形成率显著高于Ⅲ￣Ⅳ级胚胎(P<0.01);移植第5、6、7日囊胚临床妊娠率比较差异有显著统计学意义(P<0.01),囊胚冷冻移植异位妊娠发生率显著低于卵裂期冷冻胚胎移植(P<0.01)。结论:①对一些形态学上认为无冷冻价值的非优质胚胎也可延长体外培养时间培养至囊胚,筛选出具有发育潜能的胚胎,从而可以最大限度地利用胚胎,减少患者的损失;②移植第5日形成的囊胚可获得更高的妊娠率;③囊胚移植可有效防止异位妊娠的发生。     

乙肝病毒携带对不同卵巢储备功能女性体外受精-胚胎移植结局的影响

目的探讨乙肝病毒携带对不同卵巢储备功能女性进行体外受精-胚胎移植(IVF-ET)助孕胚胎发育及妊娠结局的影响。方法回顾性分析接受IVF-ET助孕的1 310例不孕症患者资料,按照血清抗苗勒管激素(AMH)水平,分为三组:卵巢储备低下组(A组)AMH2μg/L,正常卵巢储备组(B组)AMH 2~7μg/L,卵巢高储备组(C组)AMH7μg/L,每组按HBs Ag检测结果分为女方乙肝病毒携带组和正常对照组,比较两组的正常受精率、卵裂率、优质胚胎率、着床率、临床妊娠率及流产率有无差异。结果 A组及C组中,乙肝病毒携带组与正常对照组的正常受精率、卵裂率、优质胚胎率、着床率及临床妊娠率差异无统计学意义(P0.05),但A组中乙肝病毒携带组的无可移植胚胎率(14.6%)高于正常对照组(5.9%)(P0.05);B组中乙肝病毒携带组的正常受精率(69.8%)、卵裂率(96.97%)、优质胚胎率(21.8%)、着床率(31.3%)及临床妊娠率(44.1%)均低于正常对照组(73.6%,98.6%,26.2%,41.3%,59.8%)(P0.05),差异有统计学意义。3组中乙肝病毒携带组的流产率均高于正常对照组(P0.05),差异有统计学意义。结论乙肝病毒携带可能干扰了卵巢储备低下及正常卵巢储备女性的卵子质量及胚胎的发育,最终影响妊娠结局。     

Embryo implantation in in vitro fertilization and intracytoplasmic sperm injection: impact of cleavage status, morphology grade, and number of embryos transferred.

OBJECTIVE: The aims of this study were to compare preimplantation embryo quality in intracytoplasmic sperm injection (ICSI) with standard IVF and to examine the impact of age and number and quality of embryos transferred on implantation and pregnancy. DESIGN: Retrospective, controlled clinical study. SETTING: Academic tertiary center. PATIENT(S): We examined 211 consecutive couples undergoing ICSI who were matched with 211 couples undergoing IVF therapy during the same time frame. INTERVENTION(S): In vitro embryo culture. MAIN OUTCOME MEASURE(S): Day 3 embryo quality as judged by the number of blastomeres and morphology scoring. RESULT(S): Patients undergoing ICSI had a significantly reduced number of embryos with good morphology and cleavage compared with IVF cases. Nevertheless, pregnancy and abortion rates were similar when adjusted by age and number of embryos transferred. Average cleavage status and age were significant predictors of implantation. Women of advanced age had significantly lower embryo cleavage and implantation rates. CONCLUSION(S): [1] The cleaving status of day 3 embryos is a valuable, although limited, indicator of implantation outcome. [2] In vitro fertilization-derived embryos had better cleavage rates and morphology scores than ICSI-derived embryos; however, the implantation potential was similar for both groups. [3] The age-related decline in implantation rate was associated with impaired embryo growth rates.     

Differential growth of human embryos in vitro: role of reactive oxygen species

OBJECTIVE: To examine the relationship of early human embryonic development with the level of reactive oxygen species (ROS) in the culture media on the first day (day 1 ROS) after insemination. DESIGN: A prospective study. SETTING: Patients undergoing assisted reproduction in a teaching hospital. PATIENT(S): Patients undergoing conventional IVF (n = 104; 115 cycles) and intracytoplasmic sperm injection (ICSI) (n = 91; 96 cycles) were included. Both fertilization and early cultures were performed in human tubal fluid with 5% serum substitute supplement. INTERVENTION(S): Day 1 ROS levels in the central well (sample) and the outer well (control) of each embryo culture dish were measured after overnight incubation by chemiluminescence assay using luminol as the probe. MAIN OUTCOME MEASURE(S): Fertilization rate and embryo quality at day 3 and 5 were recorded for each cycle. Age, parity, and demographic features were also compared. RESULT(S): High day 1 ROS levels in culture media were associated with low blastocyst rate, low fertilization rate, low cleavage rate, and high embryonic fragmentation with ICSI but not with conventional IVF. High day 1 ROS levels in culture media were associated with lower pregnancy rates in both IVF and ICSI cycles. CONCLUSION(S): Reactive oxygen species generated in culture media by day 1 may be an important biochemical marker for early embryonic growth. Increased embryonic fragmentation and slow cleavage rate may be partially attributed to early exposure of embryos to high ROS levels in ICSI cycles. Differential growth of ICSI embryos incubated under identical conditions may be in part due to differences in ROS levels of the culture medium surrounding these embryos.     

Cleavage speed and implantation potential of early-cleavage embryos in IVF or ICSI cycles

We examined whether there is a correlation among early embryo cleavage, speed of cleavage, and implantation potential for in-vitro fertilization (IVF) treatment and intracytoplasmic sperm injection (ICSI). This retrospective study examined 112 cycles of IVF and 82 cycles of ICSI in patients less than 40 years of age. Early cleavage was defined as embryonic mitosis occurring 25–27 h after insemination. These day-3 embryos were then grouped according to cleavage speed (rapid, normal, and slow) and morphological quality (good or poor). A larger proportion of early-cleavage embryos developed normally compared to non-early-cleavage embryos (IVF: 69.1 % vs. 47.1 %, respectively; ICSI: 63.0 % vs. 45.6 %, respectively). The early-cleavage embryos also produced more good quality embryos than the non-early-cleavage embryos (IVF: 80.2 % vs. 56.4 %, respectively; ICSI: 73.4 % vs. 59.4 %). The implantation rate was significantly higher with early-cleavage embryos in both IVF (42.9 % vs. 19.7 %) and ICSI (48.1 % vs. 24 %). These results indicate that early-cleavage embryos have a higher rate of normal development and develop into better quality embryos on day 3, resulting in more and higher quality embryos to choose from for day-3 embryo transfer. Thus, early cleavage may be a useful criterion when selecting embryos for IVF or ICSI.     

月经期取卵在卵巢低储备患者IVF-ET中的应用

目的:探讨月经期取卵在卵巢低储备(diminished ovarian reserve,DOR)患者体外受精-胚胎移植(IVF-ET)中应用的可行性。方法:回顾性分析70例DOR行IVF/卵胞质单精子注射(ICSI)-ET治疗的不孕症患者的临床资料,比较其73个月经期取卵和270个非月经期取卵的结局。若月经2~4 d阴道超声提示优势卵泡直径≥14 mm且E2水平200 ng/L则行月经期取卵,若无优势卵泡按常规促排卵方案行IVF/ICSI,观察其临床结局。结果:月经期组获卵数、成熟卵数和可用胚胎数分别为1.0±0.4个、0.8±0.4个、0(0,1)个,非月经期组分为1.6±1.2个、1.4±1.1个、1(0,1)个,组间有统计学差异(P0.05)。月经期组周期取消率为72.6%,显著高于非月经期组43.0%(P0.05)。月经期组获卵率、卵裂率、卵子利用率分别为83.1%、94.7%和34.5%,非月经期组分别为70.6%、96.7%和51.7%,组间无统计学差异(P0.05)。结论:尽管月经期取卵的获卵数、成熟卵数、可用胚胎数小于非月经期取卵,但获卵率、卵裂率和卵子利用率组间无统计学差异,为反复周期取消、高基础雌激素的DOR不孕症患者节约了治疗时间,提供了新的方法。     

薄型子宫内膜新鲜胚胎和冻融胚胎移植妊娠结局比较

目的探讨在薄型子宫内膜患者中新鲜胚胎移植与冻融胚胎移植(FET)妊娠结局的差异。方法回顾性分析接受体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)治疗采用长方案胚胎移植h CG注射日与冻融周期胚胎移植内膜转化日的内膜厚度≤7 mm的患者共592个周期的临床资料。将移植周期按胚胎是否冻融分为新鲜胚胎移植组(n=173)和FET组(n=419)。比较组间的胚胎种植率、临床妊娠率、流产率、多胎率和异位妊娠率有无差异。结果新鲜胚胎移植组患者平均移植胚胎(2.1±0.4)枚,与FET组患者平均移植胚胎(2.1±0.5)枚比较,组间有统计学差异(P0.05);按照移植胚胎数分为3个亚组,新鲜胚胎移植组1枚胚胎者,妊娠率为7.7%,2枚者为30.2%,3枚者为23.8%;FET组1枚胚胎者15.6%,2枚者为34.9%,3枚者为41.6%,新鲜胚胎移植组与FET组间差异均无统计学意义(P0.05)。组间着床率、流产率、异位妊娠率等结果也均无统计学差异(P0.05)。移植3枚胚胎新鲜组多胎率(80.0%)高于FET组(29.7%)(P0.05)。新鲜胚胎移植组多胎率3个亚组间有统计学差异(P0.05),FET组妊娠率和流产率3个亚组间均有统计学差异(P0.05)。将移植胚胎数作为协变量,纳入Logistics回归模型对结果变量进行分析,说明周期类型与临床妊娠率间无显著相关性(OR=0.726,95%CI=0.504~1.104)。结论子宫内膜厚度≤7 mm的薄型内膜患者新鲜胚胎移植和FET妊娠结局相似,选择新鲜周期移植不影响妊娠结局并可缩短治疗周期,降低总费用。     

两种不同胚胎装载技术对体外受精-胚胎移植及冻融胚胎移植临床结局的影响

目的探讨两种不同胚胎装载技术对体外受精-胚胎移植(IVF-ET)和冻融胚胎移植(FET)临床妊娠率及胚胎种植率的影响。方法回顾性分析了543个新鲜胚胎移植周期及658个FET周期。根据移植时胚胎装载方法分为A组(含胚培养液体积周围空气体积)和B组(含胚培养液体积周围空气体积)。比较两种胚胎装载方法对妊娠结局的影响。结果新鲜周期中,B组的临床妊娠率(64.52%)显著高于A组(54.62%)(P0.05),种植率组间虽无统计学差异(P0.05),但B组明显高于A组。FET周期中卵裂胚移植B组的临床妊娠率(49.43%)明显高于A组(38.24%),但没有统计学差异(P0.05),B组(34.62%)的种植率显著高于A组(23.61%)(P0.05)。囊胚移植两组的妊娠率和种植率均没有统计学差异(P0.05),但B组比A组有增高的趋势。结论胚胎移植时含胚培养液体积周围空气体积会显著提高IVF-ET和FET的临床妊娠率和种植率。     

Does female age affect embryo morphology?

Deteriorating oocyte quality is commonly believed to be the primary determinant of the decreased implantation potential in older women. We assessed the influence of age on embryo morphology in standard in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) modalities. All 6350 consecutive embryos (2990 IVF, 3360 ICSI) obtained in our Assisted Reproductive Technology Unit from January 1996 through June 1997 were included. High quality embryos were defined as those with equal-sized blastomeres and < 10% fragmentations and a cleavage rate of four cells on day 2 or eight cells on day 3 transfers. The results were analyzed for the standard IVF group, the ICSI group, and the ICSI subgroup with severe male factor infertility (< or = 1 x 10(6) total motile spermatozoa in the ejaculate). For standard IVF, a positive association was observed between female age and increased proportion of good quality embryos. No such association was detected for the ICSI cycles (whole group or subgroup). We conclude that in standard IVF, embryo quality, as reflected by embryo morphology, does not deteriorate with increased maternal age.     

Prognostic value of the pronuclear morphology pattern of zygotes for implantation rate

INTRODUCTION: In ICSI and conventional IVF cycles, the embryos are usually selected for transfer based on evaluation of the cleavage speed and the extent of blastomere fragmentation. Pronuclear stage scoring system has been used in IVF recently as an additional parameter. OBJECTIVES: The aim of this study was to classify embryos from ICSI cycles according to the pronuclear scoring system and its influence on implantation rate. MATERIAL AND METHODS: 62 couples suffering from different types of infertility and treated by ICSI were included in our study. For each embryo, the following data were analyzed: pronuclei (PN) morphology, 16-20 hours after ICSI, and embryo morphology, about 40-42 (day 2) and 65-68 (day 3) hours after ICSI. The embryo transfer was performed on the third day after pick-up. RESULTS: In 55 (88.7%) cases we transferred at least one embryo from the zygotes of 0 or 1 or 2 pattern. The implantation rate was 30.6% (n = 19). In all of these cases the embryos have been derived from zygotes from pattern 0, 1 or 2. CONCLUSIONS: Pronuclear scoring system of zygotes appears to be a predictor of the implantation potential. Embryos derived from pattern 0, 1 and 2 of zygotes implant at a higher rate (p = 0.05).     

Morphological aspect of embryos obtained after fertilization in vitro for male factor or ICSI

OBJECTIVE: In order to study the eventual impact on fertilization and embryo characteristics of the microinjection procedure we compared the quality of the embryos obtained by ICSI with those of in vitro fertilization with male factors (MF IVF). MATERIAL AND METHODS: One hundred thirty-four cycles of IVF treatment (group 1) were selected with oligoasthenozoospermia according to WHO criteria with a total number of motile spermatozoa between 500,000 and 1 million. One thousand eighty-eight mature oocytes and 486 embryos were obtained. One hundred forty-three cycles of intracytoplasmic sperm injection (group 2) were performed in couples whose in vitro fertilization was imparticable because of extreme sperm impairment. One thousand one hundred forty-seven mature oocytes were injected and 626 embryos were obtained. RESULTS: In group 1, the pregnancy rate per embryo transfer and the implantation rate were respectively 22.7% and 12.3%. In group 2, the pregnancy rate per embryo transfer was 37.1% and the implantation rate was 17%. The statistical analysis of the embryos obtained in the two different groups did not demonstrate any difference in the distribution of the more regular and less fragmented embryos (group A) and those of the more irregular and fragmented embryos (group B). No statistical difference was demonstrated in the chronology of the division of these embryos (groups 1 and 2). CONCLUSION: The pregnancy rate by cycle and by transfer reported by ICSI (p < 0.003 and p < 0.015 respectively) could be related to a significantly higher mean number of transferred embryos (2.65 vs 2.02) in probable relation with a higher cleavage rate (p < 0.00001).