P-169在2025年，cIVF的隔夜人工授精仍然是黄金标准吗？14680个卵母细胞的夜间授精与短时间授精（4-6小时）

IF 6 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Human reproduction Pub Date : 2025-06-28 DOI:10.1093/humrep/deaf097.478

B Gonzalez Marti, A C Cordeiro, C Gonzalez Trigo, C Pessah, F Entezami

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This timing should theoretically prevent the missing of the premature fading of the pronuclei before fertilization assessment. However, some embryos can display faster events. Incubation of inseminated oocytes in a time-lapse incubator could avoid missed pronuclei observation if the recording begins rapidly after the IT, but this timing doesn’t fit to an OI. Study design, size, duration Prospective observational study in a single private hospital on 1472 patients who underwent cIVF during 2023-2024. According to oocyte retrieval timing, patients were assigned to two groups: 992 patients underwent OI (group A) and 480 patients underwent SID (group B). Fertilization rate, morphokinetics, total blastulation rate, top blastulation rate, clinical pregnancy and miscarriage rates were studied in both groups. Participants/materials, setting, methods Patient’s allocation to study groups was only based on pick-up timing, regardless of indication, female age, or attempt’s rank. 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引用次数: 0

摘要

研究问题：在cIVF中，常规过夜授精（OI）与短时间授精（SID）后受精率、胚胎特征、形态动力学和妊娠率的比较。在我们的队列中，SID提高了受精评估的准确性，增加了总囊胚率和最高囊胚率，而怀孕率。根据ESHRE指南，人工授精时间（IT）应根据原核消退前16-18小时的检查时间来确定。这就是为什么，交配通常在下午进行，包括雄性和雌性配子的夜间共同孵化。这个时间理论上可以防止在受精评估前原核过早褪色的缺失。然而，一些胚胎可以显示更快的事件。在延时培养箱中孵育授精卵母细胞可以避免错过原核观察，如果记录在IT之后迅速开始，但这个时间不适合成骨不全。研究设计、规模、持续时间在一家私立医院对2023-2024年间接受cIVF治疗的1472例患者进行前瞻性观察性研究。根据取卵时间，将患者分为两组：成骨不全（A组）992例，SID （B组）480例。观察两组受精率、形态动力学、总囊胚率、顶囊胚率、临床妊娠率和流产率。受试者/材料、环境、方法将患者分配到研究组仅基于取药时间，而不考虑适应症、女性年龄或尝试级别。14680个卵母细胞授精后，在第1天OI（9872个卵母细胞）和第0天SID（4808个卵母细胞）的延时中去除卵丘细胞并将卵母细胞转移到新的培养皿中。囊胚分级采用加德纳分类法。统计学分析采用卡方检验、fisher检验和学生检验，软件为RStudio2023.09.1。A组与B组患者年龄差异无统计学意义（37.1±4.3 vs 37.4±3.9），p >；0.05)。卵母细胞成熟率(81.6% vs 77.9%, p <；0.05)，观察2PN (71.9% vs 66.4%, p <；0.05), 3PN (6.9% vs 11.0%, p <；0.05)和1PN率(7.6% vs 4.2%, p <；0.05)。然而，在全球施肥（2PN+3PN）率(79.0% vs 77.0%, p >；0.05)。施肥失败和扩展培养失败也有显著差异(6.0% vs 9.0%, p <；0.05和15.0% vs 11.0%, p <；0.05)。总囊胚率有统计学差异(66.3% vs 73.2%, p <；0.05)，胚泡率最高(46.3% vs 50.9%, p <；0.05)。两组每次移植和每个周期的妊娠率差异有统计学意义(36.0% vs 47.0%和22.0%；28.8%, p <；0.05)。当观察每次移植和每个周期的持续妊娠率时，没有发现显著差异，尽管SID的结果更高（26.0% vs 35.0%, 16.0% vs 21.0%）， p >；0.05)。两组的流产率相似(29.0% vs 26.0%, p >；0.05)。成骨不全患者较高的2PN率可能是由于隔夜成熟卵母细胞受精较晚所致。3PN在SID中的过度表现可能是由于该事件在OI中缺失，而不是有害的影响。相反，在成骨不全症中，由于对非同步2PN衰减的不准确观察时间，1PN似乎更高。研究结果的更广泛意义OI可能会产生高水平的活性氧，这些活性氧来源于与精子细胞的过多孵育时间，这可能对胚胎培养结果产生不利影响。SID的优点是避免了这种特定的偶然性。同时，从第0天开始的连续受精卵监测提高了受精评估的准确性，平衡了实验室的工作量。试验注册号

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P-169 Is the overnight insemination for cIVF still a gold standard in 2025? Overnight insemination versus short insemination duration (4-6hours) for 14680 oocytes

Study question Comparison of fertilization rate, embryo features, morphokinetics and pregnancy rate after a conventional overnight insemination (OI) versus a short insemination duration (SID) in cIVF. Summary answer In our cohort, SID improves the accuracy of fertilization assessment, increases the total and top blastulation rates as whereas the pregnancy rate. What is known already Based on the ESHRE guidelines¹, the insemination time (IT) should be decided according to the checking time after 16-18 hours and before pronuclei fading. That’s why, usually the IT takes place in the afternoon of the pick-up and consists of co-incubation of male and female gametes overnight. This timing should theoretically prevent the missing of the premature fading of the pronuclei before fertilization assessment. However, some embryos can display faster events. Incubation of inseminated oocytes in a time-lapse incubator could avoid missed pronuclei observation if the recording begins rapidly after the IT, but this timing doesn’t fit to an OI. Study design, size, duration Prospective observational study in a single private hospital on 1472 patients who underwent cIVF during 2023-2024. According to oocyte retrieval timing, patients were assigned to two groups: 992 patients underwent OI (group A) and 480 patients underwent SID (group B). Fertilization rate, morphokinetics, total blastulation rate, top blastulation rate, clinical pregnancy and miscarriage rates were studied in both groups. Participants/materials, setting, methods Patient’s allocation to study groups was only based on pick-up timing, regardless of indication, female age, or attempt’s rank. After insemination of 14680 oocytes, cumulus-cells were removed and oocytes were transferred into new dishes in the time-lapse at day-1 for the OI (9872 oocytes) and at day-0 for the SID (4808 oocytes). Gardner’s classification was used for blastocyst grading. The statistical analyses were done by chi-square, fisher test and student test using RStudio2023.09.1. Main results and the role of chance No statistical difference was observed for the patients age in group A compared to group B (37.1±4.3 vs 37.4±3.9, p > 0.05). A significant difference was observed in oocyte maturity rate (81.6% vs 77.9%, p < 0.05) and in the observation of 2PN (71.9% vs 66.4%, p < 0.05), 3PN (6.9% vs 11,0%, p < 0.05) and 1PN rates (7.6% vs 4.2%, p < 0.05). However, there was no difference in the global fertilization (2PN+3PN) rate (79.0% vs 77.0%, p > 0.05). There were also significant differences in both fertilization and extended culture failures (6.0% vs 9.0%, p < 0.05 and 15.0% vs 11.0%, p < 0.05). Total blastulation rate was statistically different (66.3% vs 73.2%, p < 0.05) and likewise the top blastulation rate (46.3% vs 50.9%, p < 0.05). The pregnancy rate per transfer and per cycle in the two groups were statistically different (36.0% vs 47.0% and 22.0%; 28.8%, p < 0.05). When observing the ongoing pregnancy rate per transfer and per cycle no significant differences were seen although results were higher in the SID (26.0% vs 35.0% and 16.0% vs 21.0%, p > 0.05). The miscarriage rate was similar in both groups (29.0% vs 26.0%, p > 0.05). Limitations, reasons for caution Higher 2PN rate in OI may be due to late fertilization of overnight matured oocytes. Over-representation of 3PN in SID may be due to this event’s missing in the OI rather than a deleterious effect. Conversely, in OI, 1PN seems higher due to inaccurate observation timings of non-simultaneous 2PN fadings. Wider implications of the findings OI may create high levels of reactive oxygen species derived from excessive incubation time with sperm-cells, which can adversely affect embryo culture outcome. SID has the advantage of avoiding this specific contingency. Simultaneously, continuous inseminated oocyte monitoring from day-0 improves the accuracy of fertilization assessment and balances laboratory workload. Trial registration number No

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来源期刊

Human reproduction 医学-妇产科学

CiteScore

10.90

自引率

6.60%

发文量

1369

审稿时长

1 months

期刊介绍： Human Reproduction features full-length, peer-reviewed papers reporting original research, concise clinical case reports, as well as opinions and debates on topical issues. Papers published cover the clinical science and medical aspects of reproductive physiology, pathology and endocrinology; including andrology, gonad function, gametogenesis, fertilization, embryo development, implantation, early pregnancy, genetics, genetic diagnosis, oncology, infectious disease, surgery, contraception, infertility treatment, psychology, ethics and social issues.