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35至42岁女性在轻度卵巢刺激周期中针对复发性流产和反复种植失败进行的非整倍体植入前基因检测:活产率、儿童发育随访及胚胎分级

Preimplantation Genetic Testing for Aneuploidy for Recurrent Pregnancy Loss and Recurrent Implantation Failure in Minimal Ovarian Stimulation Cycle for Women Aged 35-42 Years: Live Birth Rate, Developmental Follow-up of Children, and Embryo Ranking.

作者信息

Kato Keiichi, Kuroda Tomoko, Yamadera-Egawa Rie, Ezoe Kenji, Aoyama Naoki, Usami Akemi, Miki Tetsuya, Yamamoto Toshiyuki, Takeshita Toshiyuki

机构信息

Kato Ladies Clinic, 7-20-3 Nishishinjyuku, Shinjyuku-ku, 160-0023, Tokyo, Japan.

Institute of Medical Genetics, Tokyo Women's Medical University, Tokyo, 162-0054, Japan.

出版信息

Reprod Sci. 2023 Mar;30(3):974-983. doi: 10.1007/s43032-022-01073-z. Epub 2022 Sep 9.

Abstract

This study was aimed at exploring the benefits of preimplantation genetic testing for aneuploidy (PGT-A) in ensuring a successful pregnancy in patients with recurrent pregnancy loss (RPL) caused by an abnormal number of chromosomes in the embryo and recurrent implantation failure (RIF). Thirty-two patients who underwent PGT-A (18 in the RIF protocol and 14 in the RPL protocol) were enrolled in the study, and 2556 patients who did not undergo PGT-A during the same in vitro fertilization (IVF) treatment period were enrolled as controls. All patients underwent minimal stimulation cycle IVF. In the RPL protocol, the live birth rate per embryo transfer (ET) and that per patient were higher with PGT-A (80.0% each) than without it (0% each; P = 0.0050), and the rate of miscarriages was lower with PGT-A than without it (20.0% vs. 100.0%, P = 0.0098). In the RIF protocol, there were no significant differences in the live birth rate per ET and in the rate of miscarriages between groups with and without PGT-A-90.0% vs. 69.2% (P = 0.2313) and 0% vs. 10.0% (P = 0.3297), respectively. None of the children whose mothers underwent PGT-A presented adverse findings at a 1.5-year developmental check-up. In conclusion, PGT-A in RPL is advantageous for improving the live birth rate per ET and that per patient in minimal stimulation cycle IVF; it reduces the rate of miscarriages. In addition, PGT-A might be more beneficial for embryo selection than the existing morphological grades of blastocysts, resulting in earlier conception.

摘要

本研究旨在探讨胚胎染色体数目异常导致的复发性流产(RPL)和反复种植失败(RIF)患者进行胚胎植入前非整倍体基因检测(PGT-A)对成功妊娠的益处。32例行PGT-A的患者(18例采用RIF方案,14例采用RPL方案)纳入本研究,2556例在同一体外受精(IVF)治疗周期未行PGT-A的患者作为对照。所有患者均接受微刺激周期IVF。在RPL方案中,PGT-A组每胚胎移植(ET)和每位患者的活产率(均为80.0%)高于未行PGT-A组(均为0%;P = 0.0050),且PGT-A组流产率低于未行PGT-A组(20.0% vs. 100.0%,P = 0.0098)。在RIF方案中,PGT-A组与未行PGT-A组每ET活产率及流产率无显著差异,分别为90.0% vs. 69.2%(P = 0.2313)和0% vs. 10.0%(P = 0.3297)。母亲行PGT-A的儿童在1.5岁发育检查时均未出现不良结果。总之,RPL患者行PGT-A有利于提高微刺激周期IVF中每ET及每位患者的活产率;降低流产率。此外,PGT-A在胚胎选择方面可能比现有的囊胚形态学分级更具优势,从而实现更早受孕。

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