Kato Ladies Clinic, Tokyo, Japan.
Department of Obstetrics and Gynaecology, Tokushima University, Tokushima, Japan.
J Assist Reprod Genet. 2023 Nov;40(11):2669-2680. doi: 10.1007/s10815-023-02926-5. Epub 2023 Sep 4.
We evaluated whether preimplantation genetic testing for aneuploidy (PGT-A) could increase the cumulative live birth rate (CLBR) in patients with recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL).
The clinical records of 7,668 patients who underwent oocyte retrieval (OR) with or without PGT-A were reviewed for 365 days and retrospectively analyzed. Using propensity score matching, 579 patients in the PGT-A group were matched one-to-one with 7,089 patients in the non-PGT-A (control) group. Their pregnancy and perinatal outcomes and CLBRs were statistically compared.
The live birth rate per single vitrified-warmed blastocyst transfers (SVBTs) significantly improved in the PGT-A group in all age groups (P < 0.0002, all). Obstetric and perinatal outcomes were comparable between both groups regarding both RIF and RPL cases. Cox regression analysis demonstrated that in the RIF cases, the risk ratio per OR was significantly lower in the PGT-A group than in the control group (P = 0.0480), particularly in women aged < 40 years (P = 0.0364). However, the ratio was comparable between the groups in RPL cases. The risk ratio per treatment period was improved in the PGT-A group in both RIF and RPL cases only in women aged 40-42 years (P = 0.0234 and P = 0.0084, respectively).
Increased CLBR per treatment period was detected only in women aged 40-42 years in both RIF and RPL cases, suggesting that PGT-A is inappropriate to improve CLBR per treatment period in all RIF and RPL cases.
我们评估了胚胎植入前遗传学检测(PGT-A)是否可以提高复发性植入失败(RIF)和复发性流产(RPL)患者的累积活产率(CLBR)。
回顾性分析了 7668 例接受卵母细胞采集(OR)的患者的临床记录,随访时间为 365 天。采用倾向评分匹配法,将 PGT-A 组的 579 例患者与非 PGT-A(对照组)的 7089 例患者进行一对一匹配。比较两组患者的妊娠和围产儿结局及 CLBR。
在所有年龄段,PGT-A 组的单个冷冻解冻囊胚移植(SVBT)的活产率均显著提高(均 P<0.0002)。RIF 和 RPL 病例两组间的产科和围产儿结局相似。Cox 回归分析表明,在 RIF 病例中,PGT-A 组的每个 OR 的风险比明显低于对照组(P=0.0480),尤其是年龄<40 岁的女性(P=0.0364)。然而,两组 RPL 病例的比值相似。在 RIF 和 RPL 病例中,只有年龄在 40-42 岁的女性的每个治疗期的风险比在 PGT-A 组中得到改善(P=0.0234 和 P=0.0084)。
仅在 RIF 和 RPL 病例中年龄在 40-42 岁的女性中发现每个治疗期的 CLBR 增加,这表明 PGT-A 并不适合改善所有 RIF 和 RPL 病例的每个治疗期的 CLBR。