Center for Reproductive Medicine, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Reprod Biol Endocrinol. 2020 May 12;18(1):43. doi: 10.1186/s12958-020-00595-y.
The blastocyst morphology provided valuable roles for predicting pregnancy and live birth, but was still not fully understood for evaluating miscarriage. The aim of this study was to explore the association between blastocyst morphologic evaluation and first trimester miscarriage combined with karyotype of miscarried conceptus.
This retrospective cohort study included a total of 2873 clinical pregnancy cycles with single blastocyst transfer performed from January 2013 to April 2019. Chromosome karyotype of miscarried conceptus was analyzed via single nucleotide polymorphism array analysis. Miscarriage and karyotype of miscarried conceptus associated with blastocyst morphology were analyzed by chi-square and logistic regression analysis.
A total of 354 (12.3%) cycles resulted in first trimester miscarriage. Miscarriage rates increased with trophectoderm (TE) grade from A to C (P = 0.012), while three morphologic parameters (blastocoele expansion degree, inner cell mass (ICM) and TE) showed no statistical significance with miscarriage after multivariable analysis. The rate of aneuploidy was 47.7% (83 of 174) in total miscarried conceptuses. For euploid miscarriages, the grade B of ICM occupied a higher proportion compared with aneuploidy, with OR of 2.474, (95% CI, 1.311-4.699), P = 0.005.
Chromosomal aberration of embryo is an important genetic factor for first trimester miscarriage, and the quality of ICM is a potential indicator for euploid miscarriage. Blastocysts with grade A of ICM should be given priority during single blastocyst transfer to reduce potential miscarriage.
囊胚形态为预测妊娠和活产提供了有价值的作用，但对于评估流产仍不完全了解。本研究旨在探讨囊胚形态评估与流产相关联的原因，并结合流产胚胎的核型进行分析。
本回顾性队列研究共纳入 2873 个接受单囊胚移植的临床妊娠周期，这些周期均于 2013 年 1 月至 2019 年 4 月进行。通过单核苷酸多态性微阵列分析对流产胚胎的染色体核型进行分析。采用卡方检验和 logistic 回归分析囊胚形态与流产及流产胚胎核型的关系。
共有 354（12.3%）个周期发生了早期流产。流产率随着滋养外胚层（TE）等级从 A 级到 C 级而增加（P=0.012），而三个形态学参数（囊胚腔扩张程度、内细胞团（ICM）和 TE）在多变量分析后与流产无统计学意义。在总共流产的胚胎中，非整倍体的发生率为 47.7%（83/174）。对于整倍体流产，ICM 等级 B 所占比例高于非整倍体，优势比为 2.474（95%可信区间，1.311-4.699），P=0.005。
胚胎染色体异常是早期流产的一个重要遗传因素，而 ICM 的质量是整倍体流产的一个潜在指标。在单囊胚移植中，应优先考虑 ICM 等级为 A 的囊胚，以降低潜在的流产风险。
