Fertility Center of Dallas, Baylor University Medical Center, Dallas, TX.
Department of Obstetrics and Gynecology, Baylor University Medical Center, Dallas, TX.
Am J Obstet Gynecol. 2021 Aug;225(2):155.e1-155.e11. doi: 10.1016/j.ajog.2021.02.037. Epub 2021 Mar 12.
The clinical pregnancy rates among patients with uterus transplantation have been reported by only a limited number of centers, and those centers have not used preimplantation genetic testing for aneuploidy in their protocol.
This study examined clinical pregnancy rates among women with absolute uterine-factor infertility undergoing in vitro fertilization using good-quality, expanded-blastocyst-stage, euploid embryos after uterus transplantation.
This cohort observational study involved 20 women who underwent uterus transplantation over 3 years. Notably, 14 of these patients had successful transplants and were followed prospectively for a median of 14.1 months (range, 11-34.8 months). In vitro fertilization was performed before subjects underwent uterus transplantation, and good-quality expanded-blastocyst-stage euploid embryos were obtained and frozen for future embryo transfer. Interventions consisted of in vitro fertilization, preimplantation genetic testing for aneuploidy, uterus transplantation, and frozen embryo transfer.
All 14 subjects with successful transplants underwent single embryo transfer of a warmed, good-quality, euploid, expanded blastocyst and had at least 1 documented clinical pregnancy within the uterus. In 71.4%, the first embryo transfer resulted in clinical pregnancy. The median time from successful uterus transplantation to first embryo transfer was 4.5 months; from successful uterus transplantation to first clinical pregnancy, 7.3 months; and from successful uterus transplantation to first live birth, 14.1 months. A total of 13 live births have occurred in 12 subjects.
Women with absolute uterine-factor infertility who have surgically successful uterus transplantation and in vitro fertilization using preimplantation genetic testing for aneuploidy can achieve high clinical pregnancy rates. We have reduced the time interval from uterus transplantation to embryo transfer by at least 50% and the interval from uterus transplantation to clinical pregnancy by >6 months compared with previous studies. We believe our approach may shorten the time from transplant to clinical pregnancy and therefore decrease patient exposure to immunosuppressant therapies.
仅有少数中心报告了子宫移植患者的临床妊娠率，而且这些中心在其方案中并未使用胚胎植入前遗传学检测来筛查非整倍体。
本研究旨在探讨子宫移植后接受体外受精治疗的绝对子宫因素不孕女性的临床妊娠率，这些女性使用的是优质的、囊胚期扩展胚胎，且经过胚胎植入前遗传学检测筛查出了非整倍体。
本队列观察性研究纳入了 3 年内接受子宫移植的 20 名女性。值得注意的是，其中 14 名患者的移植手术成功，并前瞻性随访了中位数为 14.1 个月（范围 11-34.8 个月）。在接受子宫移植之前，这些患者接受了体外受精，获得了优质的囊胚期扩展胚胎，并将其冷冻以备将来进行胚胎移植。干预措施包括体外受精、胚胎植入前遗传学检测筛查非整倍体、子宫移植和冷冻胚胎移植。
所有 14 名移植成功的患者均接受了单个解冻的优质、整倍体、囊胚期扩展胚胎的移植，并在子宫内至少有 1 次临床妊娠记录。在 71.4%的患者中，第一次胚胎移植即获得临床妊娠。从子宫移植成功到第一次胚胎移植的中位时间为 4.5 个月；从子宫移植成功到第一次临床妊娠的中位时间为 7.3 个月；从子宫移植成功到第一次活产的中位时间为 14.1 个月。12 名患者中有 13 人分娩。
对于手术成功的子宫移植后接受体外受精且使用胚胎植入前遗传学检测筛查非整倍体的绝对子宫因素不孕女性，可以获得较高的临床妊娠率。与之前的研究相比，我们将从子宫移植到胚胎移植的时间间隔至少缩短了 50%，从子宫移植到临床妊娠的时间间隔缩短了 6 个月以上。我们相信，我们的方法可能会缩短从移植到临床妊娠的时间，从而减少患者接受免疫抑制剂治疗的时间。
