小卵泡(<8 mm)来源胚胎囊胚化延迟:一项回顾性时差成像分析
Embryos derived from small follicles (<8 mm) exhibit delayed blastulation: a retrospective time-lapse analysis
摘要
该回顾性研究纳入18名ICSI患者的62枚囊胚(<8 mm卵泡来源20枚,≥11 mm来源42枚),用时差成像比较形态动力学。结果显示早期卵裂事件无差异,但<8 mm组tSB和tB约晚8小时,第5天囊胚形成率较低;总体及第6天囊胚率、整倍体率无显著差异(活检胚胎数少)。结论:小卵泡来源胚胎囊胚化延迟,但延迟本身不应视为发育潜能受损。
原文摘要
BACKGROUND: Oocytes from small follicles are frequently discarded, although they may represent an additional resource in patients with few available oocytes. This study aimed to evaluate whether blastocysts derived from follicles <8 mm exhibit altered morphokinetic patterns compared with those from larger follicles. METHODS: This retrospective study analyzed 62 blastocysts from 18 women undergoing ICSI: 20 from follicles <8 mm and 42 from follicles ≥11 mm. Morphokinetic parameters (tPNa-tB) were recorded by time-lapse monitoring. As several women contributed to both groups, linear mixed models with a random intercept for patient accounted for clustering. Oocyte- and embryo-level rates were compared using generalized estimating equations with patient as the clustering variable. RESULTS: No between-group differences were observed for tPNa, tPNf or t2-t8. tSB occurred later in the <8 mm group (median 101.2 vs 95.3 h; p = 0.001), as did tB (108.1 vs 104.3 h; p=0.004). Differences persisted after accounting for within-patient clustering (tSB β = 7.91 h; tB β=8.29 h; both p<0.001). Day-5 blastocyst formation per fertilized oocyte was lower in the <8 mm group (28.8% vs 49.3%; p = 0.040), whereas overall blastocyst formation (38.5% vs 56.5%; p = 0.105) and day-6 rates (9.6% vs 7.2%; p = 0.683) did not differ significantly after accounting for within-patient clustering. Euploidy rates did not differ significantly between blastocysts derived from follicles <8 mm (5/10, 50.0%) and ≥11 mm (7/23, 30.4%; p = 0.433), although the number of biopsied embryos was small. Frozen-thawed single embryo transfer of two euploid blastocysts derived from follicles <8 mm resulted in two live births. CONCLUSIONS: Follicle size is associated with the timing of blastocyst development, with embryos from smaller follicles showing an approximately 8-hour delay in blastulation. Day-6 blastocyst rates and euploidy rates did not differ significantly between groups. These exploratory findings suggest that delayed blastulation alone should not be taken as evidence of impaired developmental potential in embryos derived from small follicles.
推荐理由:直接回应ART实验室是否丢弃小卵泡卵母细胞的现实问题,时差成像证据提示囊胚化延迟不等于潜能受损;但样本量小、回顾性且为探索性研究,结论需谨慎看待。
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