Abstract：Objective: To investigate the correlation among the blastocyst development speed, the degree of blastocyst expansion, the level of inner cell mass, and the level of trophoblast cells and their euploidy status and pregnancy outcomes in preimplantation genetic testing cycles. Methods: A total of 237 preimplantation genetic testing for aneuploidy(PGT-A) cycles and 127 resuscitation transplant cycles from October 2017 to January 2021 in the Center of Reproductive Medicine, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University were included in the study. The relationship among embryo development speed and morphological characteristics, euploidy and pregnancy outcome was analyzed. Results: ① In 237 biopsy cycles included for analysis, 975 blastocysts were successfully detected, including 479 euploid blastocysts(49.13%) and 496 aneuploid blastocysts(50.87%).② After considering the correction factors, the euploid rate of blastocysts on the 6th and 7th day was significantly lower than that on the 5th day(OR=0.640, 95% CI: 0.493~0.830, P=0.001). The euploidy rate of cell masses in blastocyst grade B was significantly lower than that in grade A (OR=0.235, 95% CI: 0.123-0.449, P<0.001); the euploidy rate of blastocyst trophoblast of grade C was significantly lower than that of biopsy blastocyst of grade A (OR=0.360, 95% CI: 0.192-0.674, P=0.001). The degree of blastocyst expansion has no association with the euploid state. ③ Before and after age correction, there were no difference in clinical pregnancy rate between blastocyst formation time group, blastocyst expansion degree group, inner cell grade group and trophoblast cell group. Conclusion: In PGT-A cycles, the blastocyst development rate, the grade of inner cell mass and the grade of trophoblast cells were significantly correlated with the status of euploidy, while the degree of blastocyst expansion was not correlated with the status of euploidy. There was no correlation between the early pregnancy outcomes of euploidy embryo transfer cycles and the time of blastocyst formation, the grade of inner cell mass, the grade of trophoblast cells and the degree of blastocyst expansion.
［1］Kamath MS, Mascarenhas M, Kirubakaran R, et al. Number of embryos for transfer following in vitro fertilisation or intracytoplasmic sperm injection［J］. Cochrane Database Syst Rev, 2020, 8: D3416.
［2］Tiitinen A. Single embryo transfer: Why and how to identify the embryo with the best developmental potential［J］. Best Pract Res Clin Endocrinol Metab, 2019, 33(1): 77-88.
［3］Cutting R. Single embryo transfer for all［J］. Best Pract Res Clin Obstet Gynaecol, 2018, 53: 30-37.
［4］漆倩荣, 罗金, 王雅琴, 等. 不同发育天数囊胚移植策略分析［J］. 生殖医学杂志, 2020, 29(12): 1563-1568.
［5］姚亚超, 陈仕萍, 刘寒艳, 等. 冻融移植D5非优质囊胚和D6优质囊胚对妊娠结局的影响［J］. 中国妇幼保健, 2021, 36(14): 3295-3297.
［6］Zhang HN, Ying YF, Xi HT, et al. Comparison of pregnancy outcomes between singlemorula embryo transfer and singleblastocyst transfer in fresh IVF/ICSI cycles［J］. Med Sci Monit, 2021, 27: e928737.
［7］Gardner DK, Balaban B. Assessment of human embryo development using morphological criteria in an era of timelapse, algorithms and ‘OMICS’: is looking good still important?［J］. Mol Hum Reprod, 2016, 22(10): 704-718.
［8］王林玉, 施文韬, 黄梦楠, 等. 不同指征患者胚胎植入前非整倍体筛查的比较［J］. 中国妇幼健康研究, 2019, 30(12): 1552-1556.
［9］柏海燕, 刘晓娟, 刘茜桐, 等. 非整倍体筛查中囊胚形成时间与检测结果及妊娠结局的相关性研究［J］. 生殖医学杂志, 2020, 29(8): 1024-1028.
［10］Minasi MG, Colasante A, Riccio T, et al. Correlation between aneuploidy, standard morphology evaluation and morphokinetic development in 1730 biopsied blastocysts: a consecutive case series study［J］. Human Reproduction, 2016, 31(10): 2245-2254.
［11］Wang A, Kort J, Behr B, et al. Euploidy in relation to blastocyst sex and morphology［J］. J Assist Reprod Genet, 2018, 35(9): 1565-1572.
［12］申春艳, 张建瑞, 杜姗姗, 等. 胚胎形态学参数与整倍体状态的相关性分析［J］. 中华生殖与避孕杂志, 2021, 41(6): 522-527.
［13］施文浩, 张四林, 王永博, 等. 植入前遗传学筛查中不同形态特征的胚胎整倍体率比较［J］. 中国妇幼健康研究, 2018, 29(1): 45-48.
［14］Barash OO, Ivani KA, Willman SP, et al. Association between growth dynamics, morphological parameters, the chromosomal status of the blastocysts, and clinical outcomes in IVF PGS cycles with single embryo transfer［J］. J Assist Reprod Genet, 2017, 34(8): 1007-1016.
［15］郑爱燕, 王玮, 蒲艳, 等. 胚胎发育形态学和动力学特征在胚胎选择中的应用价值［J］. 生殖医学杂志, 2021, 30(5): 588-593.
［16］Hashimoto S, Amo A, Hama S, et al. Growth retardation in human blastocysts increases the incidence of abnormal spindles and decreases implantation potential after vitrification［J］. Hum Reprod, 2013, 28(6): 1528-1535.
［17］Shapiro BS, Daneshmand ST, Restrepo H, et al. Matchedcohort comparison of singleembryo transfers in fresh and frozenthawed embryo transfer cycles［J］. Fertil Steril, 2013, 99(2): 389-392.
［18］Klimczak AM, Pacheco LE, Lewis KE, et al. Embryonal mitochondrial DNA: relationship to embryo quality and transfer outcomes［J］. J Assist Reprod Genet, 2018, 35(5): 871-877.
［19］张媔秋, 李欣, 凌秀凤, 等. 囊胚发育速度及形态学评分对冻融周期单囊胚移植临床结局的影响［J］. 江苏医药, 2020, 46(7): 681-684, 688.
［20］Capalbo A, Rienzi L, Cimadomo D, et al. Correlation between standard blastocyst morphology, euploidy and implantation: an observational study in two centers involving 956 screened blastocysts［J］. Human Reproduction, 2014, 29(6): 1173-1181.
［21］刘培昊, 李鸿昌, 朱月婷, 等. 高育龄女性行胚胎植入前遗传学筛查的妊娠结局分析［J］. 中华生殖与避孕杂志, 2019, 39(6): 436-441.
［22］李彦奇, 庞敏, 李维娟, 等. PGTA在复发性自然流产患者中的应用［J］. 新疆医学, 2019, 49(10): 961-963.
［23］Simopoulou M, Sfakianoudis K, Maziotis E, et al. PGTA: who and when? A systematic review and network metaanalysis of RCTs［J］. J Assist Reprod Genet, 2021, 38(8): 1939-1957.
［24］杨小璇, 王菁, 沈鉴东, 等. 不同特征患者胚胎植入前遗传学检测结果和治疗结局分析［J］. 生殖医学杂志, 2020, 29(7): 857-864.
［25］黄海雁, 张惠玲, 陈肖娟. 胚胎植入前遗传学筛查(PGS)在高龄和复发性流产(RSA)患者中的应用价值［J］. 中国优生与遗传杂志, 2020, 28(2): 195-197.
