不要以"貌"取胚胎，妳可能會因為太"勢利眼"而失去"生機"！ morphology euploidy ccs acghHum Reprod. 2014 Jun;29(6):1173-81 2014年6月有一份研究，登在人類生殖期刊，這一份Capalbo A1研究最特別˙的地方是他找了兩家試管嬰兒中心，全部做第5天胚胎囊胚期切片進行染色體分析，但切片前他先以外貌幫胚胎打分數：分成最優、優、一般、不良（the excellent, good, average and poor blastocyst） 分好之後再進行胚胎切片，結果發現最優胚胎有超過一半是染色體異常，更驚人的是最優的胚胎裡面正常的染色體胚胎只有56.4％，43.6％是染色體異常，最不良的胚胎也有25.5％是染色體正常，當然外觀優去猜染色體正常大部份會猜對，但是有時候妳也會看走眼，猜錯。 把這些最優、優、一般般、最不優胚胎植入子宮，最驚人的是最後段班的著床率最高53.8％，最資優的居然只有49.1％的著床率，大家最擔心第6天胚胎植入成功率較低，但是第6天著床率是51.3％，相較於第5天48.8％毫不遜色。 分析中也發現第13.16.18.21.22號這些染色體最容易產生異常，研究最後建議即便是妳非常瞧不起的胚胎，也有4分之一是染色體正常的，所以研究苦口婆心建議在差的胚胎只要長得到膨脹囊胚，妳還是手下留情切片檢查染色體，以免遺珠之憾。 Hum Reprod. 2014 Jun;29(6):1173-81. doi: 10.1093/humrep/deu033. Epub 2014 Feb 26. Correlation between standard blastocyst morphology, euploidy and implantation: an observational study in two centers involving 956 screened blastocysts. Capalbo A1, Rienzi L, Cimadomo D, Maggiulli R, Elliott T, Wright G, Nagy ZP, Ubaldi FM. Author information Abstract STUDY QUESTION: Does conventional blastocyst morphological evaluation correlate with euploidy (as assessed by comprehensive chromosome screening (CCS) of trophectoderm (TE) biopsies) and implantation potential? SUMMARY ANSWER: A moderate relation between blastocyst morphology and CCS data was observed but the ability to implant seems to be mainly determined by the chromosomal complement of preimplantation embryos rather than developmental and morphological parameters conventionally used for blastocyst evaluation. WHAT IS KNOWN ALREADY: Combined with improving methods for cryopreservation and blastocyst culture, TE biopsy and CCS is considered to be a promising approach to select euploid embryos for transfer. Understanding the role of morphology in blastocyst stage preimplantation genetic screening (PGS) cycles may help in further optimizing the cycle management and clinical outcomes. STUDY DESIGN, SIZE, DURATION: This is a multicenter retrospective observational study performed between January 2009 and August 2013. The study includes the data analysis of 956 blastocysts with conclusive CCS results obtained from 213 patients following 223 PGS cycles. Single frozen embryo transfer (FET) cycles of 215 euploid blastocysts were performed where it was possible to track the implantation outcome of each embryo transferred. PARTICIPANTS/MATERIALS, SETTING, METHODS: PGS was offered to infertile patients of advanced maternal age (>35 years) and/or with a history of unsuccessful IVF treatments (more than two failed IVF cycles) and/or previous spontaneous abortion (more than two spontaneous miscarriages). Prior to TE biopsy for CCS, blastocyst morphology was assessed and categorized in four groups (excellent, good, average and poor quality). The developmental rate of each embryo reaching the expanded blastocyst stage was defined according to the day of biopsy post-fertilization. Day 5 and Day 6 biopsied blastocysts were defined as faster and slower growing embryos, respectively. A novel blastocyst biopsy method, not requiring the opening of the zona pellucida at the cleavage stage of embryo development, was used. Linear regression models were used to test the relationship between blastocyst morphology and developmental rate CCS data and FET cycle outcomes of euploid blastocysts. MAIN RESULTS AND THE ROLE OF CHANCE: Among the embryological variables assessed (morphology and developmental rate), only blastocyst morphology was predictive of the CCS data. The euploidy rate was 56.4, 39.1, 42.8 and 25.5% in the excellent, good, average and poor blastocyst morphology groups, respectively. A diagnosis of complex aneuploidy was also associated with blastocyst morphology (P < 0.01) with 6.8, 15.2, 17.4 and 27.5% of excellent, good, average and poor quality embryos, respectively, showing multiple chromosome errors. Faster and slower growing embryos showed a similar aneuploidy rate. Regression logistic analysis showed that none of the parameters used for conventional blastocyst evaluation (morphology and developmental rate) was predictive of the implantation potential of euploid embryos. The implantation potential of euploid embryos was the same, despite different morphologies and developmental rates. LIMITATIONS, REASONS FOR CAUTION: The study is limited by its retrospective nature. A higher sample size or a prospective randomized design could be used in future studies to corroborate the current findings. WIDER IMPLICATIONS OF THE FINDINGS: This study provides knowledge for a better laboratory and clinical management of blastocyst stage PGScycles suggesting that the commonly used parameters of blastocyst evaluation are not good enough indicators to improve the selection among euploid embryos. Accordingly, all poor morphology and slower growing expanded blastocysts should be biopsied and similarly considered for FET cycles. This knowledge will be of critical importance to achieve similar cumulative live birth rates in PGS programs compared with conventional IVF, avoiding the potential for exclusion of low quality but viable embryos from the biopsy and transfer procedures. Future research to identify non-invasive biomarkers of reproductive potential may further enhance selection among euploid blastocysts. STUDY FUNDING/COMPETING INTEREST(S): No funding was obtained for the study. All authors have no conflicts to declare. TRIAL REGISTRATION NUMBER: None. KEYWORDS: aneuploidies, blastocyst biopsy, blastocyst morphology, embryo evaluation, preimplantation genetic screening