Patounakis George, Bergh Eric, Forman Eric J, Tao Xin, Lonczak Agnieszka, Franasiak Jason M, Treff Nathan, Scott Richard T
National Institutes of Health, Bethesda, MD, USA.
Mount Sinai School of Medicine, New York, NY, USA.
J Assist Reprod Genet. 2016 Jan;33(1):67-73. doi: 10.1007/s10815-015-0606-z. Epub 2015 Nov 6.
The aim of the study is to determine if thrombophilic single nucleotide polymorphisms (SNPs) affect outcomes in fresh in vitro fertilization (IVF) cycles in a large general infertility population.
A prospective cohort analysis was performed at a university-affiliated private IVF center of female patients undergoing fresh non-donor IVF cycles. The effect of the following thrombophilic SNPs on IVF outcomes were explored: factor V (Leiden and H1299R), prothrombin (G20210A), factor XIII (V34L), β-fibrinogen (-455G → A), plasminogen activator inhibitor-1 (4G/5G), human platelet antigen-1 (a/b9L33P), and methylenetetrahydrofolate reductase (C677T and A1298C). The main outcome measures included positive pregnancy test, clinical pregnancy, embryo implantation, live birth, and pregnancy loss.
Patients (1717) were enrolled in the study, and a total of 4169 embryos were transferred. There were no statistically significant differences in positive pregnancy test, clinical pregnancy, embryo implantation, live birth, or pregnancy loss in the analysis of 1717 patients attempting their first cycle of IVF. Receiver operator characteristics and logistic regression analyses showed that outcomes cannot be predicted by the cumulative number of thrombophilic mutations present in the patient.
Individual and cumulative thrombophilic SNPs do not affect IVF outcomes. Therefore, initial screening for these SNPs is not indicated.
本研究旨在确定血栓形成倾向单核苷酸多态性(SNP)是否会影响广大普通不孕人群新鲜体外受精(IVF)周期的结局。
在一家大学附属的私立IVF中心,对接受新鲜非供体IVF周期的女性患者进行前瞻性队列分析。探讨了以下血栓形成倾向SNP对IVF结局的影响:凝血因子V(莱顿突变和H1299R)、凝血酶原(G20210A)、凝血因子XIII(V34L)、β-纤维蛋白原(-455G→A)、纤溶酶原激活物抑制剂-1(4G/5G)、人类血小板抗原-1(a/b9L33P)以及亚甲基四氢叶酸还原酶(C677T和A1298C)。主要结局指标包括妊娠试验阳性、临床妊娠、胚胎着床、活产和妊娠丢失。
1717例患者纳入本研究,共移植4169枚胚胎。在对尝试首次IVF周期的1717例患者的分析中,妊娠试验阳性、临床妊娠、胚胎着床、活产或妊娠丢失方面均无统计学显著差异。受试者工作特征曲线和逻辑回归分析表明,患者体内存在的血栓形成倾向突变累积数量无法预测结局。
个体及累积的血栓形成倾向SNP不影响IVF结局。因此,无需对这些SNP进行初始筛查。