快篩胚胎一條龍試管嬰兒訂做優生寶寶: 婦產科醫學年會先驅性研究：胚胎快篩「一條龍式試管嬰兒」助好孕

2015年4月30日星期四

婦產科醫學年會先驅性研究：胚胎快篩「一條龍式試管嬰兒」助好孕

婦產科醫學年會先驅性研究：胚胎快篩「一條龍式試管嬰兒」助好孕

在2015年3月15日的婦產科醫學年會中，有許多新技術及眾多學術論文發表，其中彰化博元婦產科蔡鋒博醫師發表的「一條龍式試管嬰兒」研究更是受人矚目。

國內目前的試管嬰兒技術已經相當成熟，懷孕率與歐美並駕齊驅。

目前有待突破的關鍵點在於如何選擇健康的胚胎植回子宮，

以及在胚胎著床階段究竟受何因素的影響，如胚胎著床之窗，

這些議題依舊是醫界努力研究的領域。

蔡醫師說明，現在的試管嬰兒技術，

傳統是應用光學顯微鏡觀察，依據胚胎外觀形態來選擇胚胎，目測的結果當然也有可能選錯胚胎，比如：外觀優質,但染色體異常。正常健康的胚胎有23對染色體，分別從精子及卵細胞各取一條染色體，共46條染色體。

如何選擇染色體正常的整倍胚胎、選到最有潛力著床的胚胎，

是試管嬰兒治療成功最關鍵的步驟。

染色體不整倍將導致胚胎無法著床或流產，

這也是在試管嬰兒治療中，最需要被克服的問題之一。

在「一條龍式試管嬰兒」研究中，是將試管嬰兒囊胚期胚胎切片以qPCR(即時定量聚合酶連鎖反應儀)進行PGS胚胎著床前染色體診斷，

因為胚胎快篩:胚胎切片檢測染色體較快速，所以可以不必為了等待判讀結果而冷凍胚胎，可以直接新鮮胚胎植入子宮。

在發表的先驅性的臨床研究中，三個月內收集了15個案例，總共分析了163個囊胚，不整倍的染色體胚胎占39.2%，扣除不整倍的染色體胚胎後，整倍體胚胎著床率為:53.8%。

初步結果有相當好的懷孕率及胚胎的著床率，15個案例中有11例懷孕，因病人數較少，不能遽下結論，

仍須收集更多案例，才能提供更有力的臨床證據。

蔡醫師表示，在試管嬰兒的治療中，選擇染色體正常的胚胎可望提高懷孕率、

降低流產率，而以qPCR進行胚胎快篩染色體之胚胎快篩「一條龍式試管嬰兒」技術的應用，

將對於有基因遺傳疾病、反覆流產的病人有相當大的幫忙。

Application of q-PCR to preimplantation genetic screening: A pilot study

試管嬰兒囊胚期胚胎切片以qPCR進行PGS胚胎著床前染色體診斷，不必冷凍，直接新鮮胚胎植入子宮:先驅性研究

蔡鋒博*1, 陳昭雯1, 林招彰1, 張舜評2,3, 馬國欽 2, ,張月嬌1,陳曉青1,徐慧鈴1,潘孟麗1,張琇媛1,施俐君1陳明 2,4,5

Feng-Po Tsai1, Chao-Wen Chen1, Chao-Chang Lin1, Shun-Ping Chang2,3, Gwo-Chin Ma2, Yueh-Chiao Chang1,Hsiao-Ching Chen1,Hui-Ling Hsu1,Meng-LI Pan1,Hsiu-Yuan Chang1,Li-Chun Shih1, Ming Chen2,4,5

Poyuan Women Clinic IVF Centre, Changhua Taiwan1

博元婦產科,不孕症試管嬰兒中心[1]

彰化基督教醫院基因醫學部[2]

中興大學生命科學系[3]

台灣大學醫學院婦產部[4]

東海大學生命科學系[5]

Introduction

Only a small fraction of embryos that can successfully implant and progress to live-birth in spite of recent advances in morphology-based embryological methodologies, selection of competent embryos is therefore a crucial step in IVF treatment. Aneuploidy is regarded as a primary etiology of implantation failure and it is vitally important to develop an effective strategy to solve this deficiency. Various measures including FISH, array CGH (SNP or oligo chromosomal microarray), and q-PCR have been reported. Among them, q-PCR seems a very promising new modality in PGS by a small number of IVF centers abroad. This pilot study aimed at analyzing the impact on implantation rate and pregnancy rate in IVF cycles using fresh embryos transfer which embryos were selected via blastocyst biopsy with rapid qPCR-based partial aneuploidy screening in our setting. It has been shown that biopsy at blastocyst stage is less detrimental in implantation potential than biopsy at Day-3 cleavage stage embryos and thus in this study, we tested a simple strategy by using q-PCR on Day5/6 blastocyst stage embryos and assessed its outcome.

Patient(s) Material and method

15 infertile couples with at least one previous IVF failure came to our clinic were enrolled. PGS was conducted by q-PCR with selectively amplified markers situated at chromosome 13, 18, 21, and X. The blastocyst biopsy was performed on day 5/6 and the sample was analyzed on the same day. The results were immediately available to the embryologist and the clinician. The euploid embryo was subsequently transferred in the fresh cycle.

Result(s)

A total of 163 blastocysts were biopsied and 4.9% of embryos (n=8) generated no result due to amplification failure. The aneuploidy rate for blastocysts was 39.2% (n=64). 26 blastocysts were transferred and implantation rate was 53.8% (n=14). Clinical pregnancy rate was 73.3% (n=11).

Conclusion

Our pilot study showed a promising high pregnancy rate and implantation rate. Despite it is yet comprehensive chromosome screening aiming at all 24 chromosomes, the strategy combines the traditional methodology by FISH and the biopsy of blastocyst followed by fresh embryo transfer, which gains an advantage of biopsy of Day-3 cleavage stage embryos. Expanding the chromosomes being investigated (from a limited set of chromosomes to all 24 chromosomes) is underway and a randomized study by comparing q-PCR and array CGH is needed in the future.

台視新聞報導博元婦產科一條龍試管嬰兒 TTV qPCR

https://www.youtube.com/watch?v=oeUzkFgSyww&feature=youtu.be