IVF/ICSI 辅助生殖周期中囊胚培养与交界性滋养细胞肿瘤风险的相关性：英国大型国家数据库分析。
Association of extended culture to blastocyst and pre-malignant gestational trophoblastic disease risk following IVF/ICSI-assisted reproduction cycles: an analysis of large UK national database.
机构信息
Department of Reproductive Medicine, Newcastle Fertility Centre at Life, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle upon Tyne, NE1 4EP, UK.
Department of Statistics, R S Metrics Asia Holdings, Battaramulla, 10120, Sri Lanka.
出版信息
J Assist Reprod Genet. 2022 Oct;39(10):2317-2323. doi: 10.1007/s10815-022-02583-0. Epub 2022 Aug 24.
PURPOSE
To assess whether there is an association between extended in vitro culture based on embryo developmental stage at transfer and pre-malignant gestational trophoblastic disease (GTD) risk of molar pregnancy during assisted reproduction.
METHODS
A retrospective study was carried out using Human Fertilization and Embryology Authority (HFEA) anonymized register from 1999 to 2016. A total of 540,376 cycles were eligible to be included in the study after excluding any kind of donor treatment or surrogacy, frozen embryo transfers, and cycles with incomplete data. Subgroup analysis was carried out in subjects with primary infertility aiming to exclude an increased risk in those with a previous GTD. Multivariate logistic regression analysis was used to adjust for possible confounders, and the effect of day of embryo transfer in IVF (in vitro fertilization)/ICSI (intracytoplasmic sperm injection) treatment on a molar pregnancy GTD outcome was analyzed.
RESULTS
The prevalence of a molar pregnancy GTD among the study population was 3.4/10,000 livebirths (53/156,683) with a higher risk in the over 40 age category. No significant difference of pre-malignant GTD incidence was seen between IVF and ICSI (0.01% vs 0.009% respectively). No association was seen with GTD based on type/cause of infertility or number of embryos transferred. Crude (1.06; 95% CI 0.852-1.31) and adjusted (1.07; 95% CI (0.857-1.32) odds ratios were calculated to see an association between day of embryo transfer and the occurrence of a GTD. There was no association between day of embryo transfer and molar GTD risk after adjusting for age and secondary infertility.
CONCLUSION
No significant association between pre-malignant molar gestational trophoblastic disease and extended in vitro embryo culture was found after analyzing 540,376 cycles of IVF and ICSI.
目的
评估基于转移时胚胎发育阶段的体外延长培养是否与辅助生殖中葡萄胎恶变的妊娠滋养细胞肿瘤（GTD）风险相关。
方法
本研究使用 1999 年至 2016 年人类受精与胚胎管理局（HFEA）匿名登记处进行了一项回顾性研究。在排除任何类型的供体治疗或代孕、冷冻胚胎移植以及数据不完整的周期后，共有 540376 个周期符合纳入标准。在原发性不孕患者中进行了亚组分析，旨在排除既往 GTD 患者风险增加的可能性。采用多变量逻辑回归分析调整可能的混杂因素，并分析体外受精（IVF）/卵胞浆内单精子注射（ICSI）治疗中胚胎移植日对葡萄胎 GTD 结局的影响。
结果
研究人群中葡萄胎 GTD 的患病率为 3.4/10000 活产儿（53/156683），年龄超过 40 岁的患者风险更高。IVF 和 ICSI 之间恶性 GTD 发生率无显著差异（分别为 0.01%和 0.009%）。根据不孕类型/原因或移植胚胎数量，GTD 发生率无差异。计算粗比值比（1.06；95%CI 0.852-1.31）和调整比值比（1.07；95%CI 0.857-1.32），以观察胚胎移植日与 GTD 发生之间的关联。调整年龄和继发性不孕后，胚胎移植日与葡萄胎恶变风险之间无关联。
结论
在分析了 540376 个 IVF 和 ICSI 周期后，未发现恶性葡萄胎滋养细胞肿瘤与体外延长胚胎培养之间存在显著关联。
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