Zheng Zhong, Zhao Xiaoming, Xu Bing, Yao Ning
Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China.
Arch Med Sci. 2018 Aug;14(5):1119-1124. doi: 10.5114/aoms.2018.72790. Epub 2018 Jan 16.
Preimplantation genetic diagnosis/screening (PGD/PGS) can effectively detect chromosomal abnormalities in an embryo but only if an embryo is available. However, not all couples can obtain an embryo that is available for testing. The purpose of this study was to identify factors which might affect the formation of PGD/PGS embryos to predict the possibility of obtaining embryos that could be detected.
In a retrospective study, we included all couples who underwent PGD/PGS at our center from January 2015 to December 2016. We compared these patients according to the non-blastocyst group and the blastocyst group.
There were 302 couples who had blastocysts in their first PGD/PGS cycle. Fifty-seven couples had no blastocysts in their PGD/PGS cycles: 43 couples had no blastocysts in one cycle; 10 in two cycles; 4 in three cycles. The non-blastocyst group was older than the blastocyst group (32.37 vs. 30.69, = 0.048). Anti-mullerian hormone (AMH, ng/ml) in the non-blastocyst group was significantly lower than in the blastocyst group (4.80 ±3.67 vs. 3.07 ±2.30, = 0.00). Women whose chromosome were aneuploid (47, XXX or 45, X) had a similar AMH level compared with others, but the number of retrieved oocytes was much lower; the normal karyotype was 14.25 and aneuploidy was 5.40 ( = 0.01) in women < 30 years old. There was the same condition in women aged 30-38 years (14.60 vs. 3.44, < 0.001). Male's different chromosome karyotype had no influence on double pronuclear number or the rate of blastocyst formation. Presence of endometriosis, polycystic ovary syndrome and tubal factor showed no difference between the blastocyst and non-blastocyst group. Nor did oligospermia and asthenospermia.
Elderly women, those with lower AMH and women with 47, XXX or 45, X have fewer ova, leading to the possibility of no blastocyst. These couples should be fully informed and weigh the advantages and disadvantages before undergoing PGD/PGS.
植入前基因诊断/筛查（PGD/PGS）能够有效检测胚胎中的染色体异常，但前提是有胚胎可供检测。然而，并非所有夫妇都能获得可用于检测的胚胎。本研究的目的是确定可能影响PGD/PGS胚胎形成的因素，以预测获得可检测胚胎的可能性。
在一项回顾性研究中，我们纳入了2015年1月至2016年12月在本中心接受PGD/PGS的所有夫妇。我们根据非囊胚组和囊胚组对这些患者进行了比较。
在其首个PGD/PGS周期中有囊胚的夫妇有302对。57对夫妇在其PGD/PGS周期中没有囊胚：43对夫妇在一个周期中没有囊胚；10对在两个周期中没有囊胚；4对在三个周期中没有囊胚。非囊胚组的年龄大于囊胚组（32.37对30.69，P = 0.048）。非囊胚组的抗苗勒管激素（AMH，ng/ml）显著低于囊胚组（4.80±3.67对3.07±2.30，P = 0.00）。染色体非整倍体（47，XXX或45，X）的女性与其他女性的AMH水平相似，但回收的卵母细胞数量要低得多；年龄<30岁的女性中，正常核型为14.25，非整倍体为5.40（P = 0.01）。30 - 38岁的女性也有同样的情况（14.60对3.44，P < 0.001）。男性不同的染色体核型对双原核数量或囊胚形成率没有影响。子宫内膜异位症、多囊卵巢综合征和输卵管因素在囊胚组和非囊胚组之间没有差异。少精子症和弱精子症也没有差异。
年龄较大的女性、AMH水平较低的女性以及染色体为47，XXX或45，X的女性卵子较少，导致没有囊胚的可能性增加。这些夫妇在接受PGD/PGS之前应充分了解情况并权衡利弊。
