Valor predictivo de los patrones de granulacion del citoplasma durante Fecundacion in vitro en ovocitos en metafase II: Parte I, pacientes con mal pronostico

Objective: To determine whether 4 cytoplasmic granulation patterns of human metaphase II oocytes have a predictive value for in vitro fertilization outcomes. Design: A retrospective cohort study. Setting: An academically affiliated private clinical infertility and research center. Patient(s): A total of 2,690 consecutive fresh autologous oocytes collected from women aged 41.2 + 5.0 years between 2017 and 2019. Intervention(s): Determination of granulation pattern in every oocyte during intracytoplasmic sperm injection as fine, central, dispersed, and newly introduced uneven granulations. Main Outcome Measure(s): Fertilization outcomes (2 pronuclei [2PN], <2PN, and >2PN rates), pregnancy, and live birth rates for different granulation patterns at different ages. Result(s): Fine granulation produced the highest 2PN rate, followed by central, uneven, and dispersed granulation (91.8%, 83.9%, 77.9%, and 54.8%, respectively). Differences in fertilization were surprisingly relatively independent of age and other variables. Overall, compared with fine granulation, dispersed granulation resulted in lower pregnancy rates (4.6% vs. 10.7%) and known-outcome analysis (1.3% vs. 5.6%) as well as lower live birth rates (3.0% vs. 8.9%) and known-outcome analysis (0.6% vs. 5.6%). The known-outcome analysis demonstrated that uneven granulation had lower live birth rates than fine granulation (2.3% vs. 5.6%). Unexpectedly, the ooplasm granulation patterns were largely disassociated from embryo morphologic grades. Conclusion(s): We, for the first time, demonstrated that 4 distinct cytoplasmic granulation patterns in metaphase II oocytes had, largely independent of age and other variables, a predictive value for fertilization, pregnancy, and live birth outcomes in in vitro fertilization cycles of poor-prognosis patients. These data suggest that upstream ooplasm granulation patterns deserve closer attention in terms of embryo selection.

Automated summary

The study showed that four distinct cytoplasmic granulation patterns in human metaphase II oocytes were predictive of fertilization, pregnancy, and live birth outcomes in in vitro fertilization cycles, largely independent of age and other variables. These findings suggest that ooplasm granulation patterns should be considered in embryo selection for poor-prognosis patients undergoing IVF.