Liu M M, Xu S L, Zhang H B, Zhang J W, Ren B N, Zhang W J, Liu Z Z, Hu J J, Guan Y C
Reproductive Center of the Third Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
Zhonghua Yi Xue Za Zhi. 2023 Aug 15;103(30):2335-2341. doi: 10.3760/cma.j.cn112137-20221204-02567.
To investigate the effect of preimplantation genetic testing for aneuploidies (PGT-A) on pregnancy outcome and perinatal outcome of single live birth in patients with unexplained recurrent spontaneous abortion (URSA). The clinical data of 351 cycles of the first transfer of a blastocyst through whole embryo freezing in the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University from 2019 to 2021 were retrospectively analyzed. According to whether PGT-A was performed before the transfer, the patients were divided into two groups: the PGT-A group (160 cycles) and the control group (191 cycles) were treated with in vitro fertilization/intracytoplasmic sperm microinjection (IVF/ICSI). To adjust for confounding factors, propensity score matching (PSM) was carried out in a 1∶1 ratio between the two groups of patients. After matching, 98 patients in the PGT-A group and 98 patients in the control group were compared for pregnancy outcome and perinatal outcome of singleton live births. Before PSM, the female age in the PGT-A group was (33.6±4.0) years, lower than that in the control group (34.5±4.5) years (=0.049). Male age in the PGT-A group was (33.6±4.1) years, lower than that in the control group (35.3±5.1) years (<0.001). There were statistically significant differences between the two groups in infertility factors, female body mass index (BMI), years of infertility, number of spontaneous abortions, basal follicle stimulating hormone (FSH), endometrial thickness on the day of transfer and the percentage of high-quality blastocysts (all values<0.05); After PSM, there was a statistically significant difference in fertilization methods and infertility factors between the two groups (<0.05), while other differences were not statistically significant (all values>0.05); There were statistically significant differences between the two groups in implant rate [63.3% (62 cycles) 49.0% (48 cycles), =0.044], clinical pregnancy rate [63.3% (62 cycles) 49.0% (48 cycles), =0.044], and live birth rate [42.9% (42 cycles) 28.6% (28 cycles), =0.037]. There was no statistically significant difference in perinatal outcomes between the PGT-A group and the control group in obtaining single birth live births (>0.05). Compared with conventional IVF/ICSI assisted pregnancy, PGT-A assisted pregnancy significantly improves implantation rate, clinical pregnancy rate, and live birth rate in URSA patients. PGT-A improves the pregnancy outcomes in URSA patients but not perinatal outcomes in patients with singleton live births.
探讨胚胎植入前非整倍体遗传学检测（PGT-A）对不明原因复发性自然流产（URSA）患者单胎活产妊娠结局及围产期结局的影响。回顾性分析2019年至2021年郑州大学第三附属医院生殖中心351个囊胚经全胚冷冻后首次移植周期的临床资料。根据移植前是否进行PGT-A，将患者分为两组：PGT-A组（160个周期）和对照组（191个周期），均采用体外受精/卵胞浆内单精子显微注射（IVF/ICSI）治疗。为调整混杂因素，对两组患者进行1∶1倾向评分匹配（PSM）。匹配后，比较PGT-A组98例患者和对照组98例患者单胎活产的妊娠结局及围产期结局。PSM前，PGT-A组女性年龄为（33.6±4.0）岁，低于对照组（34.5±4.5）岁（P=0.049）。PGT-A组男性年龄为（33.6±4.1）岁，低于对照组（35.3±5.1）岁（P<0.001）。两组在不孕因素、女性体重指数（BMI）、不孕年限、自然流产次数、基础卵泡刺激素（FSH）、移植日子宫内膜厚度及优质囊胚率方面差异均有统计学意义（均P<0.05）；PSM后，两组在受精方式和不孕因素方面差异有统计学意义（P<0.05），其他差异无统计学意义（均P>0.05）；两组在种植率[63.3%（62个周期）对49.0%（48个周期），P=0.044]、临床妊娠率[63.3%（62个周期）对49.0%（48个周期），P=0.044]和活产率[42.9%（42个周期）对28.6%（28个周期），P=0.037]方面差异有统计学意义。PGT-A组和对照组单胎活产的围产期结局差异无统计学意义（P>0.05）。与传统IVF/ICSI辅助妊娠相比，PGT-A辅助妊娠显著提高URSA患者的种植率、临床妊娠率和活产率。PGT-A改善了URSA患者的妊娠结局，但未改善单胎活产患者的围产期结局。
