整倍体胚胎植入失败后的管理策略。

Management strategies following implantation failure of euploid embryos.

作者信息

Kuroda Keiji

机构信息

Center for Reproductive Medicine and Endoscopy Sugiyama Clinic Marunouchi Tokyo Japan.

Department of Obstetrics and Gynaecology Juntendo University Faculty of Medicine Tokyo Japan.

出版信息

Reprod Med Biol. 2024 Apr 8;23(1):e12576. doi: 10.1002/rmb2.12576. eCollection 2024 Jan-Dec.

DOI:10.1002/rmb2.12576

PMID:38590944

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11000815/

Abstract

BACKGROUND

Euploid blastocyst implantation failure may result from embryonic factors undetectable by preimplantation genetic testing for aneuploidy (PGT-A); however, various nonembryonic factors can also intricately interfere with implantation. This review seeks to clarify evidence-based testing and treatments for implantation failure after euploid embryo transfer.

METHODS

We conducted a review of the literature on implantation failure after euploid embryo transfer or multiple embryo transfer cycles, which mainly included systematic reviews and meta-analyses.

RESULTS

The recommended tests for implantation failure include (1) hysteroscopy, (2) endometrial CD138 immunohistochemistry and bacterial culture, (3) serum 25-hydroxyvitamin D, and (4) thrombophilia screening. Based on diagnostic findings, the following treatments have been recommended: (1) antibiotics for chronic endometritis, (2) vitamin D replacement, (3) lifestyle modification, and (4) low-dose aspirin starting from the postimplantation period for thrombophilia. Moreover, frozen-thawed single euploid blastocyst transfer using assisted hatching and hyaluronan-enriched transfer medium may support embryo implantation.

CONCLUSION

To ensure a successful pregnancy in subsequent embryo transfers, simple, inexpensive, and evidence-based tests and treatments should be selected.

摘要

背景

整倍体囊胚着床失败可能是由于植入前非整倍体基因检测（PGT-A）无法检测到的胚胎因素所致；然而，各种非胚胎因素也可能复杂地干扰着床。本综述旨在阐明整倍体胚胎移植后着床失败的循证检测和治疗方法。

方法

我们对整倍体胚胎移植或多个胚胎移植周期后着床失败的文献进行了综述，主要包括系统评价和荟萃分析。

结果

推荐的着床失败检测方法包括：（1）宫腔镜检查；（2）子宫内膜CD138免疫组化和细菌培养；（3）血清25-羟维生素D；（4）血栓形成倾向筛查。根据诊断结果，推荐以下治疗方法：（1）慢性子宫内膜炎使用抗生素；（2）补充维生素D；（3）改变生活方式；（4）血栓形成倾向者从着床后开始使用低剂量阿司匹林。此外，使用辅助孵化和富含透明质酸的移植培养基进行冻融单整倍体囊胚移植可能有助于胚胎着床。