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一项多中心、前瞻性、盲法、非选择性研究,评估了使用靶向下一代测序的胚胎植入前遗传学检测非整倍体分析进行非整倍体诊断的预测价值以及活检的影响。

A multicenter, prospective, blinded, nonselection study evaluating the predictive value of an aneuploid diagnosis using a targeted next-generation sequencing-based preimplantation genetic testing for aneuploidy assay and impact of biopsy.

机构信息

IVI RMA New Jersey, Basking Ridge, New Jersey; Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.

Foundation for Embryonic Competence, Basking Ridge, New Jersey.

出版信息

Fertil Steril. 2021 Mar;115(3):627-637. doi: 10.1016/j.fertnstert.2020.07.052. Epub 2020 Aug 28.

Abstract

OBJECTIVE

To determine the predictive value of an aneuploid diagnosis with a targeted next-generation sequencing-based preimplantation genetic testing for aneuploidy (PGT-A) assay in prognosticating the failure of a successful delivery.

DESIGN

Prospective, blinded, multicenter, nonselection study. All usable blastocysts were biopsied, and the single best morphologic blastocyst was transferred before genetic analysis. Preimplantation genetic testing for aneuploidy was performed after clinical outcome was determined. Clinical outcomes were compared to PGT-A results to calculate the predictive value of a PGT-A aneuploid diagnosis.

SETTING

Fertility centers.

PATIENT(S): Couples undergoing their first in vitro fertilization cycle without recurrent pregnancy loss, antral follicle count < 8, or body mass index ≥ 35 kg/m.

INTERVENTION(S): None.

MAIN OUTCOME MEASURE(S): The primary outcome was the ability of the analytical result of aneuploid to predict failure to deliver (clinical result). A secondary outcome was the impact of the trophectoderm biopsy on sustained implantation.

RESULT(S): Four hundred two patients underwent 484 single, frozen, blastocyst transfers. The PGT-A aneuploid diagnosis clinical error rate was 0%. There was no difference in sustained implantation between the study group and an age-matched control group, where biopsy was not performed (47.9% vs. 45.8).

CONCLUSION(S): The PGT-A assay evaluated was highly prognostic of failure to deliver when an aneuploid result was obtained. Additionally, the trophectoderm biopsy had no detectable adverse impact on sustained implantation.

CLINICAL TRIAL REGISTRATION NUMBERS

NCT02032264 and NCT03604107.

摘要

目的

确定基于靶向下一代测序的胚胎植入前遗传学检测非整倍体(PGT-A)分析的非整倍体诊断对预测成功分娩失败的预测价值。

设计

前瞻性、盲法、多中心、非选择研究。所有可利用的囊胚均进行活检,在进行遗传分析之前转移单个最佳形态学囊胚。在确定临床结果后进行胚胎植入前遗传学检测非整倍体。将临床结果与 PGT-A 结果进行比较,以计算 PGT-A 非整倍体诊断的预测价值。

设置

生育中心。

患者

接受首次体外受精周期的夫妇,无复发性妊娠丢失,窦卵泡计数<8 或体重指数≥35 kg/m。

干预

无。

主要观察指标

主要结局是分析结果的非整倍体预测分娩失败(临床结果)的能力。次要结局是滋养外胚层活检对持续种植的影响。

结果

402 例患者接受了 484 次单冷冻囊胚移植。PGT-A 非整倍体诊断的临床错误率为 0%。研究组和未行活检的年龄匹配对照组的持续种植率无差异(47.9% vs. 45.8%)。

结论

当获得非整倍体结果时,PGT-A 分析对预测分娩失败具有高度预测价值。此外,滋养外胚层活检对持续种植没有可检测到的不良影响。

临床试验注册号

NCT02032264 和 NCT03604107。

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