Weghofer Andrea, Barad David, Li Jianming, Gleicher Norbert
Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut, USA.
Fertil Steril. 2007 Jul;88(1):90-4. doi: 10.1016/j.fertnstert.2006.11.081. Epub 2007 Feb 12.
Prematurely declining ovarian function (PDOF) affects approximately 10% of infertile females, and has been suggested to represent a shift of the normal ovarian aging curve toward younger age. Whether women with PDOF demonstrate an increased level of aneuploidy in their embryos, based on increasing aneuploidy rates with advancing female age, is unknown, and was the subject of this study.
Retrospective, case-control study.
Academically affiliated private IVF center.
PATIENT(S): Twenty women with PDOF, and 20 age-matched controls with age-appropriate ovarian function (AAOF), underwent IVF cycles and preimplantation genetic diagnosis (PGD) by fluorescence in situ hybridization for chromosomes X, Y, 13, 16, 18, 21, and 22 on day 3 after fertilization, and ET on day 5.
INTERVENTION(S): None.
MEAN OUTCOME MEASURE(S): Oocyte and embryo numbers, embryonic aneuploidy rates, pregnancies, and miscarriages.
RESULT(S): Pregnancy rates (PRs) after initial fresh ET did not differ between patients with PDOF and those with AAOF. Among a total of 258 embryos analyzed by PGD, aneuploidy rates in PDOF and AAOF cycles were 52.6% and 52.2%, respectively. A trend toward lower ongoing PRs was noted in patients with PDOF (21% versus 41%), primarily attributable to higher clinical miscarriage rates (50% versus 13%) after detection of fetal heart motion.
CONCLUSION(S): In this pilot study, the observation that PDOF is not characterized by an increased aneuploidy rate (controlled for age) suggests that PDOF does not represent a simple shift of the physiologically declining ovarian function curve toward younger age. This observation, indeed, suggests that the underlying pathophysiology of PDOF may vary from that of AAOF.
卵巢功能过早衰退（PDOF）影响约10%的不孕女性，有人认为这代表正常卵巢衰老曲线向更年轻的年龄偏移。基于随着女性年龄增长非整倍体率增加，PDOF女性胚胎中的非整倍体水平是否升高尚不清楚，这是本研究的主题。
回顾性病例对照研究。
学术附属私立体外受精中心。
20名PDOF女性和20名年龄匹配且卵巢功能正常（AAOF）的对照者，接受了体外受精周期治疗，并在受精后第3天通过荧光原位杂交对X、Y、13、16、18、21和22号染色体进行植入前基因诊断（PGD），并在第5天进行胚胎移植（ET）。
无。
卵母细胞和胚胎数量、胚胎非整倍体率、妊娠和流产情况。
首次新鲜胚胎移植后的妊娠率（PRs）在PDOF患者和AAOF患者之间没有差异。在通过PGD分析的总共258个胚胎中，PDOF周期和AAOF周期的非整倍体率分别为52.6%和52.2%。PDOF患者的持续妊娠率有降低趋势（21%对41%），主要归因于检测到胎心搏动后的临床流产率较高（50%对13%）。
在这项初步研究中，观察到PDOF的特征并非非整倍体率增加（年龄校正后），这表明PDOF并不代表生理性卵巢功能衰退曲线向更年轻年龄的简单偏移。这一观察结果确实表明，PDOF的潜在病理生理学可能与AAOF不同。
