Zhao S T, Liu Y B, Zhang Q, Ni T X, Yan J H
Center for Reproductive Medicine, Shandong University, Jinan 250012, China.
Zhonghua Yi Xue Za Zhi. 2023 Sep 26;103(36):2874-2880. doi: 10.3760/cma.j.cn112137-20221226-02698.
To investigate the impact of the number of previous miscarriages on embryo euploid rate and pregnancy outcomes after preimplantation genetic testing for aneuploidies (PGT-A) in patients with unexplained recurrent pregnancy loss (uRPL). A retrospective cohort study was conducted. 799 women with uRPL who underwent PGT-A for the first time between January 2015 and December 2021 at the Reproductive center of Shandong University were enrolled. These patients were divided into three groups according to the number of previous miscarriages (2, 3, and≥4). Stratified analysis was conducted according to female age (≤37 years and>37 years). The embryo euploidy rate, good-quality blastocyst formation rate, cumulative live birth rate, and cumulative clinical pregnancy loss rate of three groups were compared in younger and older patients, respectively. Meanwhile, the cumulative live birth rate, clinical pregnancy loss rate, and embryo euploidy rate were analyzed by multivariate logistic regression analysis. Patients' age was (34.7±5.1) years old. In the three groups with 2, 3 and ≥4 previous miscarriages, there was no significant difference in the embryo euploidy rate between groups in the younger [48.9% (539/1 103), 50.6% (354/700) and 52.1% (152/292), =0.567] and older [26.2% (103/393), 28.8% (55/191) and 20.5% (16/78), =0.377] age population. Compared with 2 and 3 previous miscarriages, the cumulative live birth rate was significantly decreased [52.6% (153/291), 52.8% (93/176) and 34.3% (25/73), =0.014] and the cumulative clinical pregnancy loss rate was significantly increased [15.8% (31/196), 15.3% (18/118) and 46.9% (23/49), <0.001] in younger women with ≥4 miscarriages. After adjusting for maternal age, BMI, AMH, endometrial thickness on hCG trigger day and antral follicle count, the number of previous miscarriages ≥4 was a relevant factor for cumulative live birth rate (=0.461, 95%: 0.263-0.807, =0.007) and the cumulative clinical pregnancy loss rate (=4.382, 95%: 2.165-8.873, <0.001) in younger patients, but it was not significantly correlated with the cumulative live birth rate, cumulative clinical pregnancy loss rate and embryo euploidy rate in patients with advanced age. In uRPL patients,≥4 previous miscarriages decreased cumulative live birth rate and increased cumulative clinical pregnancy loss rate in women aged≤37 years old.
探讨既往流产次数对不明原因复发性流产（uRPL）患者行胚胎植入前非整倍体基因检测（PGT-A）后胚胎整倍体率及妊娠结局的影响。进行一项回顾性队列研究。纳入2015年1月至2021年12月在山东大学生殖中心首次接受PGT-A的799例uRPL女性。根据既往流产次数（2次、3次和≥4次）将这些患者分为三组。根据女性年龄（≤37岁和>37岁）进行分层分析。分别比较年轻和年长患者中三组的胚胎整倍体率、优质囊胚形成率、累积活产率和累积临床妊娠丢失率。同时，通过多因素逻辑回归分析累积活产率、临床妊娠丢失率和胚胎整倍体率。患者年龄为（34.7±5.1）岁。在既往流产2次、3次和≥4次的三组中，年轻人群[48.9%（539/1103）、50.6%（354/700）和52.1%（152/292），P=0.567]和年长人群[26.2%（103/393）、28.8%（55/191）和20.5%（16/78），P=0.377]组间胚胎整倍体率无显著差异。与既往流产2次和3次相比，既往流产≥4次的年轻女性累积活产率显著降低[52.6%（153/291）、52.8%（93/176）和34.3%（25/73），P=0.014]，累积临床妊娠丢失率显著升高[15.8%（31/196）、15.3%（18/118）和46.9%（23/49），P<0.001]。在调整产妇年龄、BMI、AMH、hCG扳机日子宫内膜厚度和窦卵泡计数后，既往流产次数≥4次是年轻患者累积活产率（P=0.461，95%CI：0.263-0.807，P=0.007）和累积临床妊娠丢失率（P=4.382，95%CI：2.165-8.873，P<0.001）的相关因素，但与高龄患者的累积活产率、累积临床妊娠丢失率和胚胎整倍体率无显著相关性。在uRPL患者中，既往流产≥4次会降低年龄≤37岁女性的累积活产率并增加累积临床妊娠丢失率。
