PDF(Pubmed)
Abstract：
UNASSIGNED: We evaluate whether next-generation sequencing (NGS)-based preimplantation genetic testing for aneuploidy (PGT-A) improves the cumulative pregnancy outcomes of patients with unexplained recurrent implantation failure (uRIF) as compared to conventional in vitro fertilization or intracytoplasmic sperm injection (IVF/ICSI).
UNASSIGNED: This was a retrospective cohort study (2015-2022). A total of 705 couples diagnosed with uRIF were included in the study. 229 women transferred blastocysts based on morphological grading (IVF/ICSI) and 476 couples opted for PGT-A to screen blastocysts by NGS. Women were further stratified according to age at retrieval (<38 years and ≥38 years). The primary outcome was the cumulative live-birth rate after all the embryos were transferred in a single oocyte retrieval or until achieving a live birth. Confounders were adjusted using binary logistic regression models.
UNASSIGNED: Cumulative live-birth rate was similar between the IVF/ICSI group and the PGT-A group after stratified by age: IVF/ICSI vs PGT-A in the <38 years subgroup (49.7% vs 57.7%, adjusted OR (95% CI) = 1.25 (0.84-1.84), P = 0.270) and in the ≥38 years subgroup (14.0% vs 19.5%, adjusted OR (95% CI) = 1.09 (0.41-2.92), P = 0.866), respectively. Nonetheless, the PGT group had a lower first-time biochemical pregnancy loss rate (17.0% vs 8.7%, P = 0.034) and a higher cumulative good birth outcome rate (35.2% vs 46.4%, P = 0.014) than the IVF/ICSI group in the <38 years subgroup. Other pregnancy outcomes after the initial embryo transfer and multiple transfers following a single oocyte retrieval were all similar between groups.
UNASSIGNED: Our results showed no evidence of favorable effects of PGT-A treatment on improving the cumulative live birth rate in uRIF couples regardless of maternal age. Use of PGT-A in the <38 years uRIF patients would help to decrease the first-time biochemical pregnancy loss and increase the cumulative good birth outcome.
UNASSIGNED: This was a retrospective cohort study (2015-2022). A total of 705 couples diagnosed with uRIF were included in the study. 229 women transferred blastocysts based on morphological grading (IVF/ICSI) and 476 couples opted for PGT-A to screen blastocysts by NGS. Women were further stratified according to age at retrieval (<38 years and ≥38 years). The primary outcome was the cumulative live-birth rate after all the embryos were transferred in a single oocyte retrieval or until achieving a live birth. Confounders were adjusted using binary logistic regression models.
UNASSIGNED: Cumulative live-birth rate was similar between the IVF/ICSI group and the PGT-A group after stratified by age: IVF/ICSI vs PGT-A in the <38 years subgroup (49.7% vs 57.7%, adjusted OR (95% CI) = 1.25 (0.84-1.84), P = 0.270) and in the ≥38 years subgroup (14.0% vs 19.5%, adjusted OR (95% CI) = 1.09 (0.41-2.92), P = 0.866), respectively. Nonetheless, the PGT group had a lower first-time biochemical pregnancy loss rate (17.0% vs 8.7%, P = 0.034) and a higher cumulative good birth outcome rate (35.2% vs 46.4%, P = 0.014) than the IVF/ICSI group in the <38 years subgroup. Other pregnancy outcomes after the initial embryo transfer and multiple transfers following a single oocyte retrieval were all similar between groups.
UNASSIGNED: Our results showed no evidence of favorable effects of PGT-A treatment on improving the cumulative live birth rate in uRIF couples regardless of maternal age. Use of PGT-A in the <38 years uRIF patients would help to decrease the first-time biochemical pregnancy loss and increase the cumulative good birth outcome.
摘要：
我们评估了基于下一代测序（NGS）的非整倍性植入前遗传学检测（PGT-A）是否与传统的体外受精或卵胞浆内单精子注射（IVF/ICSI）相比，改善了无法解释的复发性植入失败（uRIF）患者的累积妊娠结局。
■这是一项回顾性队列研究（2015-2022年）。总共705对被诊断为uRIF的夫妇被纳入研究。229名妇女根据形态学分级（IVF/ICSI）转移胚泡，476对夫妇选择PGT-A通过NGS筛选胚泡。根据检索时的年龄（<38岁和≥38岁）对妇女进行进一步分层。主要结果是所有胚胎在单个卵母细胞取出中转移后或直到实现活产的累积活产率。使用二元逻辑回归模型调整混杂因素。
■按年龄分层后，IVF/ICSI组和PGT-A组的累积活产率相似：<38岁亚组的IVF/ICSIvsPGT-A（49.7％vs57.7％，调整后OR（95%CI）=1.25（0.84-1.84），P=0.270）和≥38岁亚组（14.0%vs19.5%，调整后OR（95%CI）=1.09（0.41-2.92），P=0.866),分别。尽管如此，PGT组的首次生化妊娠损失率较低（17.0%vs8.7%，P=0.034）和更高的累积良好出生结局率（35.2％vs46.4％，P=0.014）在<38年亚组中比IVF/ICSI组。初始胚胎移植后的其他妊娠结局和单个卵母细胞取出后的多次移植在组间都是相似的。
■我们的结果显示，无论母亲年龄如何，PGT-A治疗对改善uRIF夫妇的累积活产率没有有利作用。在<38岁uRIF患者中使用PGT-A将有助于减少首次生化妊娠损失并增加累积良好的分娩结局。
■这是一项回顾性队列研究（2015-2022年）。总共705对被诊断为uRIF的夫妇被纳入研究。229名妇女根据形态学分级（IVF/ICSI）转移胚泡，476对夫妇选择PGT-A通过NGS筛选胚泡。根据检索时的年龄（<38岁和≥38岁）对妇女进行进一步分层。主要结果是所有胚胎在单个卵母细胞取出中转移后或直到实现活产的累积活产率。使用二元逻辑回归模型调整混杂因素。
■按年龄分层后，IVF/ICSI组和PGT-A组的累积活产率相似：<38岁亚组的IVF/ICSIvsPGT-A（49.7％vs57.7％，调整后OR（95%CI）=1.25（0.84-1.84），P=0.270）和≥38岁亚组（14.0%vs19.5%，调整后OR（95%CI）=1.09（0.41-2.92），P=0.866),分别。尽管如此，PGT组的首次生化妊娠损失率较低（17.0%vs8.7%，P=0.034）和更高的累积良好出生结局率（35.2％vs46.4％，P=0.014）在<38年亚组中比IVF/ICSI组。初始胚胎移植后的其他妊娠结局和单个卵母细胞取出后的多次移植在组间都是相似的。
■我们的结果显示，无论母亲年龄如何，PGT-A治疗对改善uRIF夫妇的累积活产率没有有利作用。在<38岁uRIF患者中使用PGT-A将有助于减少首次生化妊娠损失并增加累积良好的分娩结局。
