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植入前基因诊断的体外受精结局:对2011 - 2012年美国辅助生殖技术监测数据的分析

Outcomes of in vitro fertilization with preimplantation genetic diagnosis: an analysis of the United States Assisted Reproductive Technology Surveillance Data, 2011-2012.

作者信息

Chang Jeani, Boulet Sheree L, Jeng Gary, Flowers Lisa, Kissin Dmitry M

机构信息

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.

出版信息

Fertil Steril. 2016 Feb;105(2):394-400. doi: 10.1016/j.fertnstert.2015.10.018. Epub 2015 Nov 6.

Abstract

OBJECTIVE

To assess the characteristics of IVF cycles for which preimplantation genetic diagnosis (PGD) was used and to evaluate indications for PGD and treatment outcomes associated with this procedure as compared with cycles without PGD with the data from the U.S. National ART Surveillance System.

DESIGN

Retrospective cohort study.

SETTING

None.

PATIENT(S): Fresh autologous cycles that involved transfer of at least one embryo at blastocyst when available.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): PGD indications and age-specific reproductive outcomes.

RESULT(S): There were a total of 97,069 non-PGD cycles and 9,833 PGD cycles: 55.6% were performed for aneuploidy screening (PGD Aneuploidy), 29.1% for other reasons (PGD Other), and 15.3% for genetic testing (PGD Genetic). In comparison to non-PGD cycles, PGD Aneuploidy cycles showed a decreased odds of miscarriage among women 35-37 years (adjusted odds ratio [aOR] 0.62; 95% CI, 0.45-0.87) and women >37 years (aOR 0.55; 95% CI, 0.43-0.70); and an increased odds of clinical pregnancy (aOR 1.18; 95% CI, 1.05-1.34), live-birth delivery (aOR 1.43; 95% CI, 1.26-1.62), and multiple-birth delivery (aOR 1.98; 95% CI, 1.52-2.57) among women >37 years.

CONCLUSION(S): Aneuploidy screening was the most common indication for PGD. Use of PGD was not observed to be associated with an increased odds of clinical pregnancy or live birth for women <35 years. PGD for aneuploidy was associated with a decreased odds of miscarriage for women >35 years, but an increased odds of a live-birth and a multiple live-birth delivery among women >37 years.

摘要

目的

利用美国国家辅助生殖技术监测系统的数据,评估采用植入前基因诊断(PGD)的体外受精周期的特征,评价PGD的适应证以及与该程序相关的治疗结局,并与未采用PGD的周期进行比较。

设计

回顾性队列研究。

地点

无。

患者

新鲜自体周期,如有囊胚则至少移植1个胚胎。

干预措施

无。

主要观察指标

PGD适应证和特定年龄的生殖结局。

结果

共有97,069个非PGD周期和9,833个PGD周期:55.6%用于非整倍体筛查(PGD非整倍体),29.1%用于其他原因(PGD其他),15.3%用于基因检测(PGD基因)。与非PGD周期相比,PGD非整倍体周期在35 - 37岁女性中流产几率降低(校正优势比[aOR] 0.62;95%可信区间[CI],0.45 - 0.87),在37岁以上女性中流产几率也降低(aOR 0.55;95% CI,0.43 - 0.70);在37岁以上女性中临床妊娠几率增加(aOR 1.18;95% CI,1.05 - 1.34)、活产分娩几率增加(aOR 1.43;95% CI,1.26 - 1.62)以及多胎分娩几率增加(aOR 1.98;95% CI,1.52 - 2.57)。

结论

非整倍体筛查是PGD最常见的适应证。未观察到PGD与35岁以下女性临床妊娠或活产几率增加相关。35岁以上女性进行非整倍体PGD与流产几率降低相关,但37岁以上女性活产和多胎活产分娩几率增加。

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