PDF(Pubmed)
Abstract：
BACKGROUND: Recurrent implantation failure (RIF) represents a vague clinical condition with an unclear diagnostic challenge that lacks solid scientific underpinning. Although euploid embryos have demonstrated consistent implantation capabilities across various age groups, a unanimous agreement regarding the advantages of preimplantation genetic testing for aneuploidy (PGT-A) in managing RIF is absent. The ongoing discussion about whether chromosomal aneuploidy in embryos significantly contributes to recurrent implantation failure remains unsettled. Despite active discussions in recent times, a universally accepted characterization of recurrent implantation failure remains elusive. We aimed in this study to measure the reproductive performance of vitrified-warmed euploid embryos transferred to the uterus in successive cycles.
METHODS: This observational cohort study included women (n = 387) with an anatomically normal uterus who underwent oocyte retrieval for PGT-A treatment with at least one biopsied blastocyst, between January 2017 and December 2021 at a university-affiliated public fertility center. The procedures involved in this study included ICSI, blastocyst culture, trophectoderm biopsy and comprehensive 24-chromosome analysis of preimplantation embryos using Next Generation Sequencing (NGS). Women, who failed a vitrified-warmed euploid embryo transfer, had successive blastocyst transfer cycles (FET) for a total of three using remaining cryopreserved euploid blastocysts from the same oocyte retrieval cycle. The primary endpoints were sustained implantation rate (SIR) and live birth rate (LBR) per vitrified-warmed single euploid embryo. The secondary endpoints were mean euploidy rate (m-ER) per cohort of biopsied blastocysts from each patient, as well as pregnancy and miscarriage rates.
RESULTS: The mean age of the patient population was 33.4 years (95% CI 32.8-33.9). A total of 1,641 embryos derived from the first oocyte retrieval cycle were biopsied and screened. We found no associations between the m-ER and the number of previous failed IVF cycles among different ranges of maternal age at oocyte retrieval (P = 0.45). Pairwise comparisons showed a significant decrease in the sustained implantation rate (44.7% vs. 30%; P = 0.01) and the livebirth rate per single euploid blastocyst (37.1% vs. 25%; P = 0.02) between the 1st and 3rd FET. The cumulative SIR and LBR after up to three successive single embryo transfers were 77.1% and 68.8%, respectively. We found that the live birth rate of the first vitrified-warmed euploid blastocyst transferred decreased significantly with the increasing number of previously failed IVF attempts by categories (45.3% vs. 35.8% vs. 27.6%; P = 0.04). A comparable decrease in sustained implantation rate was also observed but did not reach statistical significance (50% vs. 44.2 vs. 37.9%; P = NS). Using a logistic regression model, we confirmed the presence of a negative association between the number of previous IVF failed attempts and the live birth rate per embryo transfer cycle (OR = 0.76; 95% CI 0.62-0.94; P = 0.01).
CONCLUSIONS: These findings are vital for enhancing patient counseling and refining management strategies for individuals facing recurrent implantation failure. By tailoring interventions based on age and ovarian reserve, healthcare professionals can offer more personalized guidance, potentially improving the overall success rates and patient experiences in fertility treatments.
BACKGROUND: N/A.
METHODS: This observational cohort study included women (n = 387) with an anatomically normal uterus who underwent oocyte retrieval for PGT-A treatment with at least one biopsied blastocyst, between January 2017 and December 2021 at a university-affiliated public fertility center. The procedures involved in this study included ICSI, blastocyst culture, trophectoderm biopsy and comprehensive 24-chromosome analysis of preimplantation embryos using Next Generation Sequencing (NGS). Women, who failed a vitrified-warmed euploid embryo transfer, had successive blastocyst transfer cycles (FET) for a total of three using remaining cryopreserved euploid blastocysts from the same oocyte retrieval cycle. The primary endpoints were sustained implantation rate (SIR) and live birth rate (LBR) per vitrified-warmed single euploid embryo. The secondary endpoints were mean euploidy rate (m-ER) per cohort of biopsied blastocysts from each patient, as well as pregnancy and miscarriage rates.
RESULTS: The mean age of the patient population was 33.4 years (95% CI 32.8-33.9). A total of 1,641 embryos derived from the first oocyte retrieval cycle were biopsied and screened. We found no associations between the m-ER and the number of previous failed IVF cycles among different ranges of maternal age at oocyte retrieval (P = 0.45). Pairwise comparisons showed a significant decrease in the sustained implantation rate (44.7% vs. 30%; P = 0.01) and the livebirth rate per single euploid blastocyst (37.1% vs. 25%; P = 0.02) between the 1st and 3rd FET. The cumulative SIR and LBR after up to three successive single embryo transfers were 77.1% and 68.8%, respectively. We found that the live birth rate of the first vitrified-warmed euploid blastocyst transferred decreased significantly with the increasing number of previously failed IVF attempts by categories (45.3% vs. 35.8% vs. 27.6%; P = 0.04). A comparable decrease in sustained implantation rate was also observed but did not reach statistical significance (50% vs. 44.2 vs. 37.9%; P = NS). Using a logistic regression model, we confirmed the presence of a negative association between the number of previous IVF failed attempts and the live birth rate per embryo transfer cycle (OR = 0.76; 95% CI 0.62-0.94; P = 0.01).
CONCLUSIONS: These findings are vital for enhancing patient counseling and refining management strategies for individuals facing recurrent implantation failure. By tailoring interventions based on age and ovarian reserve, healthcare professionals can offer more personalized guidance, potentially improving the overall success rates and patient experiences in fertility treatments.
BACKGROUND: N/A.
摘要：
背景：复发性植入失败（RIF）代表了一种模糊的临床状况，具有不明确的诊断挑战，缺乏坚实的科学基础。尽管整倍体胚胎在不同年龄段表现出一致的植入能力，关于非整倍体植入前遗传学检测(PGT-A)在管理RIF方面的优势,目前尚无一致意见.关于胚胎中染色体非整倍性是否显着导致复发性植入失败的持续讨论仍未解决。尽管最近进行了积极的讨论，关于复发性植入失败的普遍接受的表征仍然难以捉摸。在这项研究中，我们旨在测量连续周期转移到子宫的玻璃化加热的整倍体胚胎的生殖性能。
方法：这项观察性队列研究包括子宫解剖正常的女性（n=387），她们接受了至少一个活检囊胚的PGT-A治疗的卵母细胞取出，2017年1月至2021年12月在一所大学附属的公共生育中心。这项研究涉及的程序包括ICSI，胚泡培养,使用下一代测序（NGS）对植入前胚胎进行滋养外胚层活检和全面的24染色体分析。女人,玻璃化加热的整倍体胚胎移植失败，使用来自同一卵母细胞回收周期的剩余冷冻保存的整倍体胚泡，进行了总共三个连续的胚泡转移周期（FET）。主要终点是每个玻璃化加热的单个整倍体胚胎的持续植入率（SIR）和活产率（LBR）。次要终点是每个患者活检囊胚队列的平均整倍体率（m-ER），以及怀孕和流产率。
结果：患者的平均年龄为33.4岁（95%CI32.8-33.9）。对来自第一个卵母细胞回收周期的总共1,641个胚胎进行了活检和筛选。我们发现，在取卵时不同范围的母体年龄之间，m-ER与先前失败的IVF周期数之间没有关联（P=0.45）。成对比较显示持续植入率显着降低（44.7％vs.30％；P=0.01）和单个整倍体囊胚的活产率（37.1％vs.25%;P=0.02)在第一和第三FET之间。连续三次单胚胎移植后的累积SIR和LBR分别为77.1%和68.8%,分别。我们发现，随着先前失败的试管婴儿尝试次数的增加，转移的第一个玻璃化加热的整倍体胚泡的活产率显着降低（45.3％vs.35.8%与27.6%；P=0.04）。持续植入率也有相当的下降，但没有达到统计学意义(50%vs.44.2vs.37.9%；P=NS）。使用逻辑回归模型，我们证实了先前IVF失败的尝试次数与每个胚胎移植周期的活产率之间存在负相关(OR=0.76;95%CI0.62~0.94;P=0.01).
结论：这些发现对于加强患者咨询和完善面临复发性植入失败的患者的管理策略至关重要。通过根据年龄和卵巢储备量身定做干预措施，医疗保健专业人员可以提供更个性化的指导，有可能改善生育治疗的总体成功率和患者体验。
背景：不适用。
方法：这项观察性队列研究包括子宫解剖正常的女性（n=387），她们接受了至少一个活检囊胚的PGT-A治疗的卵母细胞取出，2017年1月至2021年12月在一所大学附属的公共生育中心。这项研究涉及的程序包括ICSI，胚泡培养,使用下一代测序（NGS）对植入前胚胎进行滋养外胚层活检和全面的24染色体分析。女人,玻璃化加热的整倍体胚胎移植失败，使用来自同一卵母细胞回收周期的剩余冷冻保存的整倍体胚泡，进行了总共三个连续的胚泡转移周期（FET）。主要终点是每个玻璃化加热的单个整倍体胚胎的持续植入率（SIR）和活产率（LBR）。次要终点是每个患者活检囊胚队列的平均整倍体率（m-ER），以及怀孕和流产率。
结果：患者的平均年龄为33.4岁（95%CI32.8-33.9）。对来自第一个卵母细胞回收周期的总共1,641个胚胎进行了活检和筛选。我们发现，在取卵时不同范围的母体年龄之间，m-ER与先前失败的IVF周期数之间没有关联（P=0.45）。成对比较显示持续植入率显着降低（44.7％vs.30％；P=0.01）和单个整倍体囊胚的活产率（37.1％vs.25%;P=0.02)在第一和第三FET之间。连续三次单胚胎移植后的累积SIR和LBR分别为77.1%和68.8%,分别。我们发现，随着先前失败的试管婴儿尝试次数的增加，转移的第一个玻璃化加热的整倍体胚泡的活产率显着降低（45.3％vs.35.8%与27.6%；P=0.04）。持续植入率也有相当的下降，但没有达到统计学意义(50%vs.44.2vs.37.9%；P=NS）。使用逻辑回归模型，我们证实了先前IVF失败的尝试次数与每个胚胎移植周期的活产率之间存在负相关(OR=0.76;95%CI0.62~0.94;P=0.01).
结论：这些发现对于加强患者咨询和完善面临复发性植入失败的患者的管理策略至关重要。通过根据年龄和卵巢储备量身定做干预措施，医疗保健专业人员可以提供更个性化的指导，有可能改善生育治疗的总体成功率和患者体验。
背景：不适用。
