Abstract：
OBJECTIVE: To evaluate in vitro fertilization (IVF) and perinatal outcomes of donor egg and autologous cycles in patients with advanced reproductive age after undergoing single frozen euploid embryo transfer.
METHODS: A multicenter, retrospective, cohort study.
METHODS: University-affiliated and private IVF centers.
METHODS: Patients aged 39-46 years who underwent IVF with intracytoplasmic sperm injection and preimplantation genetic testing for aneuploidy using whole-chromosome sequencing with donor (n = 278) or autologous (n = 278) oocytes between October 2017 and October 2021.
METHODS: Single frozen euploid embryo transfer with donor or autologous euploid embryo.
METHODS: The main outcome measure was the live birth rate (LBR) after the first embryo transfer, calculated per embryo transfer. The secondary outcomes included the implantation rate, ectopic pregnancy rate, miscarriage rate, and gestational age and birth weight at the time of delivery.
RESULTS: Patients using donor or autologous oocytes had a similar likelihood of implantation (57.91% [51.87-63.78] vs. 57.19% [51.15-63.09]) and LBR (41.01% [95% confidence interval {CI}, 35.17-47.04] vs. 42.45% [95% CI, 36.56-48.49]). Furthermore, there were no significant differences in the ectopic pregnancy rate (0.72% [0.09-2.57] vs. 0.36% [0.01-1.99]), miscarriage rate (16.19% [12.06-21.05] vs. 14.39% [95% CI, 10.48-19.08]), gestational age (38.50 [38.08-38.92] vs. 39.16 [38.25-40.07] weeks), or birth weight of infants (2,982.25 [2,606.69-3,357.81] vs. 3,128.24 [2,962.30-3,294.17] kg). The univariate analysis showed no association between advanced maternal age and the LBR (relative risk, 1.03 [95% CI, 0.84-1.25]). Multivariate analysis using putative confounders for embryo competency found no associations with LBR (adjusted relative risk, 1.22 [95% CI, 0.75-1.98]).
CONCLUSIONS: Patients with euploid blastocysts derived from donor or autologous oocytes did not reveal statistically significant differences in the LBR, implantation rate, ectopic pregnancy rate, miscarriage rate, duration of gestation, or infant birth weight. These findings suggest that age-related reproductive decline and/or poor IVF outcomes associated with women with advanced reproductive age undergoing IVF are heavily driven by embryonic aneuploidy.
METHODS: A multicenter, retrospective, cohort study.
METHODS: University-affiliated and private IVF centers.
METHODS: Patients aged 39-46 years who underwent IVF with intracytoplasmic sperm injection and preimplantation genetic testing for aneuploidy using whole-chromosome sequencing with donor (n = 278) or autologous (n = 278) oocytes between October 2017 and October 2021.
METHODS: Single frozen euploid embryo transfer with donor or autologous euploid embryo.
METHODS: The main outcome measure was the live birth rate (LBR) after the first embryo transfer, calculated per embryo transfer. The secondary outcomes included the implantation rate, ectopic pregnancy rate, miscarriage rate, and gestational age and birth weight at the time of delivery.
RESULTS: Patients using donor or autologous oocytes had a similar likelihood of implantation (57.91% [51.87-63.78] vs. 57.19% [51.15-63.09]) and LBR (41.01% [95% confidence interval {CI}, 35.17-47.04] vs. 42.45% [95% CI, 36.56-48.49]). Furthermore, there were no significant differences in the ectopic pregnancy rate (0.72% [0.09-2.57] vs. 0.36% [0.01-1.99]), miscarriage rate (16.19% [12.06-21.05] vs. 14.39% [95% CI, 10.48-19.08]), gestational age (38.50 [38.08-38.92] vs. 39.16 [38.25-40.07] weeks), or birth weight of infants (2,982.25 [2,606.69-3,357.81] vs. 3,128.24 [2,962.30-3,294.17] kg). The univariate analysis showed no association between advanced maternal age and the LBR (relative risk, 1.03 [95% CI, 0.84-1.25]). Multivariate analysis using putative confounders for embryo competency found no associations with LBR (adjusted relative risk, 1.22 [95% CI, 0.75-1.98]).
CONCLUSIONS: Patients with euploid blastocysts derived from donor or autologous oocytes did not reveal statistically significant differences in the LBR, implantation rate, ectopic pregnancy rate, miscarriage rate, duration of gestation, or infant birth weight. These findings suggest that age-related reproductive decline and/or poor IVF outcomes associated with women with advanced reproductive age undergoing IVF are heavily driven by embryonic aneuploidy.
摘要：
目的：评估体外受精（IVF）和供体卵和自体周期的围产期结局。冷冻整倍体胚胎移植（SET/FET）。
方法：回顾性研究，多中心队列研究。
方法：大学附属和私人IVF中心。
方法：在2017年10月至2021年10月期间，使用供体（n=278）或自体（n=278）卵母细胞进行全染色体测序，接受卵胞浆内单精子注射（ICSI）和非整倍性植入前遗传学检测（PGT-A）的39-46岁患者。
方法：使用供体或自体整倍体胚胎的SET/FET主要结果指标（S）：首次胚胎移植后的活产率，每次胚胎移植计算。次要结果包括植入率，异位妊娠率,流产率,以及分娩时的胎龄和出生体重。
结果：使用供体或自体卵母细胞的患者植入可能性相似，分别为57.91%（51.87-63.78）和57.19%（51.15-63.09），p=0.93，活产率为41.01％（95％CI：35.17-47.04）与42.45％（95％CI：36.56-48.49），p=0.86。此外，异位妊娠率[0.72％（0.09-2.57）与0.36％（0.01-1.99）没有显着差异，p=1]或流产率[16.19%（12.06-21.05）对14.39%（95%CI：10.48-19.08），p=0.98],胎龄[38.50周（38.08-38.92）与39.16周（38.25-40.07），p=0.19],或婴儿出生体重[2982.25公斤（2606.69-3357.81）与3128.24公斤（2962.30-3294.17），p=0.95]。单因素分析显示，高龄产妇年龄与活产率无相关性[相对危险度（RR）1.03（IC95%：0.84-1.25）；p=0.79]。使用推定的混杂因素对胚胎能力进行多变量分析，发现与活产率没有相关性[调整后的相对风险（aRR）1.22（IC95%：0.75-1.98）;p=0.42]结论（S）：来自供体或自体卵母细胞的整倍体囊胚患者的活产率没有统计学上的显着差异，植入率,异位妊娠率,流产率,妊娠持续时间，或婴儿出生体重。这些发现表明，与年龄相关的生殖能力下降和/或与接受IVF的高龄育龄妇女相关的不良IVF结局在很大程度上是由胚胎非整倍体驱动的。
方法：回顾性研究，多中心队列研究。
方法：大学附属和私人IVF中心。
方法：在2017年10月至2021年10月期间，使用供体（n=278）或自体（n=278）卵母细胞进行全染色体测序，接受卵胞浆内单精子注射（ICSI）和非整倍性植入前遗传学检测（PGT-A）的39-46岁患者。
方法：使用供体或自体整倍体胚胎的SET/FET主要结果指标（S）：首次胚胎移植后的活产率，每次胚胎移植计算。次要结果包括植入率，异位妊娠率,流产率,以及分娩时的胎龄和出生体重。
结果：使用供体或自体卵母细胞的患者植入可能性相似，分别为57.91%（51.87-63.78）和57.19%（51.15-63.09），p=0.93，活产率为41.01％（95％CI：35.17-47.04）与42.45％（95％CI：36.56-48.49），p=0.86。此外，异位妊娠率[0.72％（0.09-2.57）与0.36％（0.01-1.99）没有显着差异，p=1]或流产率[16.19%（12.06-21.05）对14.39%（95%CI：10.48-19.08），p=0.98],胎龄[38.50周（38.08-38.92）与39.16周（38.25-40.07），p=0.19],或婴儿出生体重[2982.25公斤（2606.69-3357.81）与3128.24公斤（2962.30-3294.17），p=0.95]。单因素分析显示，高龄产妇年龄与活产率无相关性[相对危险度（RR）1.03（IC95%：0.84-1.25）；p=0.79]。使用推定的混杂因素对胚胎能力进行多变量分析，发现与活产率没有相关性[调整后的相对风险（aRR）1.22（IC95%：0.75-1.98）;p=0.42]结论（S）：来自供体或自体卵母细胞的整倍体囊胚患者的活产率没有统计学上的显着差异，植入率,异位妊娠率,流产率,妊娠持续时间，或婴儿出生体重。这些发现表明，与年龄相关的生殖能力下降和/或与接受IVF的高龄育龄妇女相关的不良IVF结局在很大程度上是由胚胎非整倍体驱动的。
