臨床婦人科産科73巻3号

2019年04月発行

今月の臨床 いまさら聞けない　体外受精法と胚培養の基礎知識 胚培養の実際

長期培養は安全か？

著者： 京野廣一¹ 菊池卓¹ 橋本朋子¹

所属機関： ¹京野アートクリニック高輪

ページ範囲：P.350 - P.354

●単一胚盤胞移植により多胎妊娠の発生機序が明らかになった．長期培養により1絨毛膜性双胎のリスクが上昇する．

●胚盤胞までの長期培養により，分割期胚移植に比較し着床率が向上する．卵巣過剰刺激症候群（OHSS）軽減・多胎防止の目的からfreeze-allのうえでの単一胚移植が推奨される．

●長期培養により体外受精児の男児率が高く，凍結融解移植児の出生児体重増加，早期産率上昇，ゲノムインプリンティング異常症の発生頻度増加傾向がみられる．

参考文献

1）Gardner DK, et al : Culture and transfer of human blastocysts increases implantation rates and reduces the need for multiple embryo transfers. Fertil Steril 69 : 84-88, 1998

2）Acharya K, et al : Freezing of all embryos in in vitro fertilization is beneficial in high responders, but not intermediate and low responders : an analysis of 82,935 cycles from the Society for Assisted Reproductive Technology registry. Fertil Steril 110 : 880-887, 2018

3）Shibuya Y, et al : A successful birth of healthy monozygotic dichorionic diamniotic（DD）twins of the same gender following a single vitrified-warmed blastocyst transfer. J Assist Reprod Genet 29 : 255-257, 2012

4）京野廣一 : 双胎の新発生機序―実際に確認された事実のみからの検証―．日本IVF会誌15 : 13-19, 2012

5）Kyono K : The precise timing of embryo splitting for monozygotic dichorionic diamniotic twins : when does embryo splitting for monozygotic dichorionic diamniotic twins occur? Evidence for splitting at the morula/blastocyst stage from studies of in vitro fertilization. Twin Res Hum Genet 16 : 827-832, 2013

6）Chang HJ, et al : Impact of blastocyst transfer on offspring sex ratio and the monozygotic twinning rate : a systematic review and meta-analysis. Fertil Steril 91 : 2381-2390, 2009

7）Ikemoto Y, et al : Prevalence and risk factors of zygotic splitting after 937848 single embryo transfer cycles. Hum Reprod 33 : 1-8, 2018

8）Hentemann MA, et al : Blastocyst transfer and gender : IVF versus ICSI. J Assist Reprod genet 26 : 433-436, 2009

9）Alfarawati S, et al : The relationship between blastocyst morphology, chromosomal abnormality, and embryo gender. Fertil Steril 95 : 520-524, 2011

10）Kaartinen HM, et al : Male gender explains increased birthweight in children born after transfer of blastocysts. Hum Reprod 30 : 2312-2320, 2015

11）菊地寿美，他 : ART出生時3,223名のフォローアップ : 胚凍結融解が児の身体発育に及ぼす影響．日本IVF会誌21 : 18-22, 2018

12）Dar S, et al : Increased risk of preterm birth in singleton pregnancies after blastocyst versus Day 3 embryo transfer : Canadian ART Register（CARTR）analysis. Hum Reprod 28 : 924-928, 2013

13）Maheschwari A, et al : Obstetrics and perinatal outcomes in singleton pregnancies resulting from the transfer of blastocyst-stage versus cleavage-stage embryos generated through in vitro fertilization treatment : a systematic review and meta-analysis. Fertil Steril 100 : 1615-1621, 2013

14）Kalra SK, et al : Entended embryo culture and an increased risk of preterm delivery. Obstet Gynecol 120 : 69-75, 2012

15）久須美真紀，他 : 体外培養・長期培養の胚発生への影響 : 動物実験と臨床データから　Possible effects of extended embryo culture on epigenetic regulations. J Mamm Ova Res 25 : 221-230, 2008

16）Maheshwaria A, et al : Should we be promoting embryo transfer at blastocyst stage? Reprod Biomed Online 32 : 142-146, 2016

17）服部裕充，他 : 生殖補助医療とインプリンティング疾患の発症．医学のあゆみ263 : 322-327, 2017

18）Ventura-Junca P, et al : In vitro fertilization（IVF）in mammals : epigenetic and developmental alterations. Scientific and bioethical implications for IVF in humans. Biol Res 48 : 68, 2015