摘要
目的探讨胚胎植入前非整倍体检测(PGT-A)对不明原因复发性流产(URSA)患者妊娠结局及单胎活产围产期结局的影响。方法回顾性收集2019—2021年URSA患者于郑州大学第三附属医院生殖医学科全胚胎冷冻首次移植1枚囊胚共351个周期的临床资料,根据移植前是否行PGT-A分为两组,PGT-A组(160个周期)和对照组(191个周期)进行体外受精/卵胞浆内单精子显微注射(IVF/ICSI),为调整混杂因素将两组患者按1∶1比例进行倾向性评分匹配(PSM),匹配后PGT-A组98个周期和对照组98个周期,比较两组患者妊娠结局及单胎活产围产期结局。结果采用PSM前,PGT-A组女方年龄为(33.6±4.0)岁,低于对照组的(34.5±4.5)岁(P=0.049)。PGT-A组男方年龄为(33.6±4.1)岁,低于对照组的(35.3±5.1)岁(P<0.001)。两组间不孕因素、女方体质指数、不孕年限、自然流产次数、基础卵泡刺激素、移植日子宫内膜厚度及优质囊胚占比差异均有统计学意义(均P<0.05)。采用PSM后,两组间授精方式、不孕因素差异均有统计学意义(均P<0.05),其他差异均无统计学意义(均P>0.05);两组间种植率[63.3%(62个周期)比49.0%(48个周期),P=0.044]、临床妊娠率[63.3%(62个周期)比49.0%(48个周期),P=0.044]、活产率[42.9%(42个周期)比28.6%(28个周期),P=0.037]差异均有统计学意义。PGT-A组与对照组获得单胎活产患者的围产期结局差异均无统计学意义(均P>0.05)。结论URSA患者行PGT-A助孕与行常规IVF/ICSI助孕相比种植率、临床妊娠率以及活产率提高;PGT-A能改善URSA患者妊娠结局,但并不能改善单胎活产患者的围产期结局。
Objective To investigate the effect of preimplantation genetic testing for aneuploidies(PGT‑A)on pregnancy outcome and perinatal outcome of single live birth in patients with unexplained recurrent spontaneous abortion(URSA).Methods The clinical data of 351 cycles of the first transfer of a blastocyst through whole embryo freezing in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from 2019 to 2021 were retrospectively analyzed.According to whether PGT‑A was performed before the transfer,the patients were divided into two groups:the PGT‑A group(160 cycles)and the control group(191 cycles)were treated with in vitro fertilization/intracytoplasmic sperm microinjection(IVF/ICSI).To adjust for confounding factors,propensity score matching(PSM)was carried out in a 1∶1 ratio between the two groups of patients.After matching,98 patients in the PGT‑A group and 98 patients in the control group were compared for pregnancy outcome and perinatal outcome of singleton live births.Results Before PSM,the female age in the PGT‑A group was(33.6±4.0)years,lower than that in the control group(34.5±4.5)years(P=0.049).Male age in the PGT‑A group was(33.6±4.1)years,lower than that in the control group(35.3±5.1)years(P<0.001).There were statistically significant differences between the two groups in infertility factors,female body mass index(BMI),years of infertility,number of spontaneous abortions,basal follicle stimulating hormone(FSH),endometrial thickness on the day of transfer and the percentage of high‑quality blastocysts(all P values<0.05);After PSM,there was a statistically significant difference in fertilization methods and infertility factors between the two groups(P<0.05),while other differences were not statistically significant(all P values>0.05);There were statistically significant differences between the two groups in implant rate[63.3%(62 cycles)vs.49.0%(48 cycles),P=0.044],clinical pregnancy rate[63.3%(62 cycles)vs.49.0%(48 cycles),P=0.044],and live birth rate[42.9%(42 cycles)vs.28.6%(28 cycles),P=0.037].There was no statistically significant difference in perinatal outcomes between the PGT‑A group and the control group in obtaining single birth live births(P>0.05).Conclusion Compared with conventional IVF/ICSI assisted pregnancy,PGT‑A assisted pregnancy significantly improves implantation rate,clinical pregnancy rate,and live birth rate in URSA patients.PGT‑A improves the pregnancy outcomes in URSA patients but not perinatal outcomes in patients with singleton live births.
作者
刘曼曼
徐诗联
张贺博
张俊韦
任炳楠
张文娟
刘朝朝
胡继君
管一春
Liu Manman;Xu Shilian;Zhang Hebo;Zhang Junwei;Ren Bingnan;Zhang Wenjuan;Liu Zhaozhao;Hu Jijun;Guan Yichun(Reproductive Center of the Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)
出处
《中华医学杂志》
CAS
CSCD
北大核心
2023年第30期2335-2341,共7页
National Medical Journal of China
基金
国家重点研发计划(2021YFC2700602)
河南省医学科技攻关计划(联合共建)项目(LHGJ20190369)
关键词
妊娠结局
复发性流产
胚胎植入前非整倍体检测
种植率
临床妊娠率
活产率
Pregnancy outcomerecurrent
Recurrent spontaneous abortion
Preimplantation genetic testing for aneuploidies
Implantation rate
Clinical pregnancy rate
Live birth rate
作者简介
通信作者:刘曼曼,Email:huakailuolanlmm@163.com
