来自异常受精卵的囊胚可以使用吗？系统回顾和荟萃分析

IF 1.5 Q3 OBSTETRICS & GYNECOLOGY

European Journal of Obstetrics and Gynecology and Reproductive Biology: X Pub Date : 2025-03-18 DOI:10.1016/j.eurox.2025.100381

Yiqing Wu , Jinglei Xue , Mixue Tu , Yifeng Liu , Dan Zhang

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引用次数: 0

摘要

目的：目前的指南不建议临床使用来自单原核（1PN）或非原核（0PN）受精卵的胚胎。然而，最近的研究表明，1PN和0PN合子可以导致健康的出生。本研究旨在探讨1PN囊胚和0PN囊胚的妊娠结局。方法检索截止到2024年3月14日的spubmed、EMBASE、Web of Science和Cochrane数据库。符合条件的研究纳入了转移0PN或1PN囊胚的参与者，两个原核囊胚（2PN）作为对照。临床妊娠率、流产率、活产率为主要观察指标。使用Mantel-Haenszel方法的随机效应模型，结果以比值比（OR）表示，置信区间（CI）为95 %。此外，还根据施肥类型进行了分层分析。采用纽卡斯尔-渥太华量表（NOS）评价纳入研究的质量。结果共纳入270篇文献，其中16篇最终纳入meta分析。总共分析了57,835个周期：1PN组为1071个周期，0PN组为2324个周期，2PN组为54,440个周期。结果表明，1PN囊胚和0PN囊胚的临床妊娠率和活产率均低于2PN囊胚。有趣的是，在接受胞浆内单精子注射（ICSI）的患者中，1PN囊胚和2PN囊胚的活产率没有显著差异，在接受体外受精（IVF）的患者中，0PN囊胚和2PN囊胚的活产率也没有显著差异。结论应慎重考虑1PN囊胚和0PN囊胚的使用，特别是在有改进的无创受精评估方法的情况下。至少，ICSI患者的1PN囊胚和IVF患者的0PN囊胚在临床实践中为面临受精异常的患者提供了可行的生育选择。

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Could blastocysts derived from abnormal fertilized zygotes be used? A systematic review and meta-analysis

Objectives

Current guidelines advise against using embryos derived from mono-pronuclei (1PN) or non-pronuclei (0PN) zygotes for clinical purposes. Nevertheless, recent studies have demonstrated that 1PN and 0PN zygotes can lead to healthy births. This study aimed to investigate the pregnancy outcomes of 1PN and 0PN blastocysts.

Methods

PubMed, EMBASE, Web of Science and Cochrane databases were searched up to 14 March 2024. Eligible studies enrolled participants transferring 0PN or 1PN blastocysts, with two pronuclei (2PN) blastocysts used as the control. Clinical pregnancy rate, miscarriage rate and live birth rate were the main outcomes. The results were presented as odds ratios (OR) with 95 % confidence intervals (CI) using random-effect models with the Mantel–Haenszel method. Additionally, a stratified analysis was conducted based on the type of fertilization. The Newcastle–Ottawa scale (NOS) was used to evaluate the quality of the included studies.

Results

In total, 270 articles were identified, with 16 ultimately included in the meta-analysis. In total, 57,835 cycles were analysed: 1071 cycles in the 1PN group, 2324 cycles in the 0PN group, and 54,440 cycles in the 2PN group. The results indicated that 1PN or 0PN blastocysts were associated with lower clinical pregnancy rates and live birth rates than 2PN blastocysts. Interestingly, there was no significant difference in live birth rate between 1PN blastocysts and 2PN blastocysts in patients undergoing intracytoplasmic sperm injection (ICSI), nor between 0PN blastocysts and 2PN blastocysts in patients undergoing in-vitro fertilization (IVF).

Conclusion

Careful consideration should be given to the utilization of 1PN and 0PN blastocysts, especially if an improved methodology of non-invasive assessment of fertilization is available. At the very least, 1PN blastocysts in patients undergoing ICSI and 0PN blastocysts in patients undergoing IVF represent viable fertility options for patients facing abnormal fertilization in clinical practice.

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来源期刊

European Journal of Obstetrics and Gynecology and Reproductive Biology: X Medicine-Obstetrics and Gynecology

CiteScore

2.20

自引率

0.00%

发文量

审稿时长

58 days