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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2018, Vol. 14 ›› Issue (06): 675 -682. doi: 10.3877/cma.j.issn.1673-5250.2018.05.009

Special Issue: ；

Original Article

Effects of time-lapse system on embryo development and pregnancy outcomes

Can Zhang1, Yanqiu Hu2,†(), Hong She2, Fang Chen2   

  1. 1. Dalian Medical University, Dalian 116044, Liaoning Province, China
    2. Reproductive Medicine Center, Northern Jiangsu People′s Hospital, Yangzhou 225001, Jiangsu Province, China
  • Received:2018-05-09 Revised:2018-10-18 Published:2018-12-01
  • Corresponding author: Yanqiu Hu
  • About author:
    Corresponding author: Hu Yanqiu, Email:
  • Supported by:
    Special Fund of Jiangsu Provincial Key Research and Development Program in 2018(BE2018685)
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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 vitro fertilization/intracytoplasmic sperm injection-embryo 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: 2018KY-104).

Results

①There 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). ③The 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 than 67.5%, 56.7% and 36.8% in control group, respectively, and all the differences were statistically significant (χ2=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% and 57.0% in control group, respectively, and both the differences were statistically significant (χ2=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 (χ2=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.

Key words: Fertilization in vitro, Embryo transfer, Time-lapse system, Sperm injections, intracytoplasmic, Pregnancy outcome, Female
表1 2组不孕症患者一般临床资料比较
组别 周期数 年龄(岁，±s) BMI(kg/m2，±s) 不孕年限[年，M(P25～P75)] 既往周期数[个，M(P25～P75)] 子宫内膜厚度(mm，±s)
女方 男方
TLS组 137 29.9±4.4 31.3±5.7 22.4±3.1 3.0(2.0～4.0) 0(0～0) 10.3±2.5
对照组 182 30.9±4.8 32.7±6.8 21.8±3.0 3.0(2.0～4.3) 0(0～1) 10.2±3.1
检验值 ? t＝－1.845 t＝－1.831 t＝1.710 Z＝－1.166 Z＝－0.948 t＝0.313
P值 ? 0.066 0.067 0.085 0.244 0.343 0.745
组别 周期数 促排卵方案[例数(%)] 授精方式[例数(%)]
长方案 拮抗剂方案 微刺激方案 其他方案 短时IVF ICSI受精
TLS组 137 96(70.1) 13(9.5) 26(19.0) 2(1.5) 105(76.6) 32(23.4)
对照组 182 112(61.5) 23(12.6) 43(23.6) 4(2.2) 152(83.5) 30(16.5)
检验值 ? χ2＝2.567 χ2＝2.359
P值 ? 0.463 0.125
组别 周期数 精子浓度[×106/mL，M(P25～P75)] 精子向前运动比例[%，M(P25～P75)] Gn用量[U，M(P25～P75)] 基础雌二醇水平[pmol/L，M(P25～P75)] 基础LH水平[IU/L，M(P25～P75)]
TLS组 137 64.1(29.4～102.2) 49.7(31.8～61.1) 2 025(1 800～2 550) 133.6(106.7～165.1) 5.3(4.1～6.8)
对照组 182 66.8(34.1～103.9) 47.0(29.5～62.0) 2 100(1 575～2 625) 129.8(99.8～175.0) 4.9(3.6～6.3)
检验值 ? Z＝—0.550 Z＝－0.414 Z＝－0.397 Z＝－0.561 Z＝－1.916
P值 ? 0.582 0.679 0.691 0.575 0.055
表2 2组不孕症患者获卵数、受精率及移植情况比较
组别 周期数 窦卵泡数[个，M(P25～P75)] 获卵数[个，M(P25～P75)] 正常受精率[%(n/n′)] 卵裂率[%(n/n′)] 移植胚胎数[%(n/n′)]
1枚 2枚
TLS组 137 12.0(9.5～15.0) 10.0(6.5～14.0) 62.3(872/1400) 98.1(839/872) 50.0(44/88) 50.0(44/88)
对照组 182 10.0(6.0～14.0) 7.0(4.0～11.3) 63.6(930/1462) 95.7(890/930) 43.5(54/124) 56.5(70/124)
检验值 ? Z＝－3.751 Z＝－4.618 χ2＝0.539 χ2＝0.039 χ2＝0.862
P值 ? <0.001 <0.001 0.463 0.578 0.353
表3 2组不孕症患者的妊娠结局[%(n/n′)]
组别 周期数 优质胚胎率 囊胚形成率 优质囊胚率 胚胎着床率 生化妊娠率 临床妊娠率
TLS组 137 72.6(621/855) 74.7(183/245) 45.3(111/245) 43.2(57/132) 62.5(55/88) 55.7(49/88)
对照组 182 67.5(601/890) 56.7(185/326) 36.8(120/326) 37.1(72/194) 49.2(61/124) 41.9(52/124)
χ2值 ? 5.411 19.660 4.192 1.210 3.678 3.899
P值 ? 0.020 <0.001 0.041 0.271 0.055 a 0.048 a
表4 2组不孕症患者采用不同授精方式的妊娠结局比较[%(n/n′)]
组别 短时IVF
周期数 优质胚胎率 囊胚形成率 优质囊胚率 生化妊娠率 胚胎着床率 临床妊娠率
TLS组 105 74.5(476/639) 68.7(135/178) 40.3(82/178) 56.9(41/72) 38.9(42/108) 48.6(35/72)
对照组 152 69.6(521/749) 57.0(163/286) 38.1(109/286) 50.5(51/101) 37.2(58/156) 41.6(42/101)
χ2值 ? 4.145 16.966 2.867 0.702 0.079 0.840
P值 ? 0.042 <0.001 0.090 0.402 0.778 0.359
组别 ICSI受精
周期数 优质胚胎率 囊胚形成率 优质囊胚率 生化妊娠率 胚胎着床率 临床妊娠率
TLS组 32 67.1(145/216) 71.6(48/67) 40.3(29/67) 87.5(14/16) 62.5(15/24) 87.5(14/16)
对照组 30 56.7(80/141) 55.0(22/44) 27.5(11/40) 43.5(10/23) 36.8(14/38) 43.5(10/23)
χ2值 3.954 3.066 2.666 7.726 3.890 7.726
P值 0.047 a 0.080 0.103 0.005 0.049 a 0.005
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