目的:比较促性腺激素释放激素(GnRH-ant)拮抗剂(GnRH-ant)方案或GnRH激动剂(GnRH-a)长方案后体外受精(IVF)周期中早期流产组织或胚泡的非整倍体率。
方法:这是一项来自大学附属生育中心的回顾性队列研究。总的来说,分析了550例接受GnRH-ant或GnRH-长方案后通过IVF/卵胞浆内单精子注射(ICSI)受孕的早期流产患者,以比较早期流产组织中的非整倍体率。为了比较囊胚的非整倍体率,还分析了使用GnRH-ant方案或GnRH-长方案的404个非整倍性(PGT-A)周期的植入前遗传测试。
结果:对于通过IVF/ICSI受孕的早期流产患者,与GnRH-一个长协议组相比,GnRH-ant方案组在早期流产组织中的非整倍体率显着更高(48.51%vs.64.19%)。关于PGT-A周期,GnRH-ant方案组的囊胚非整倍体率明显高于GnRH-a长方案组(39.69%vs.52.27%)。经过分层和多元线性回归,GnRH-ant方案与早期流产组织和胚泡的非整倍体风险增加显著相关[OR(95%CI)1.81(1.21,2.71),OR(95%CI)1.65(1.13,2.42)]。此外,GnRH-ant方案组的囊胚非整倍体率显着较高,但仅在年轻和正常卵巢反应者中[OR(95%CI)5.07(1.99,12.92)].
结论:与GnRH-一个长方案相比,GnRH-ant方案与早期流产组织和胚泡中更高的非整倍体率相关.这些结果应该在多中心确认,随机对照试验。
OBJECTIVE: To compare aneuploidy rates in early aborted tissues or blastocysts between in vitro fertilization (IVF) cycles after the gonadotropin-releasing hormone (GnRH) antagonist (GnRH-ant) protocol or the GnRH agonist (GnRH-a) long protocol.
METHODS: This was a retrospective cohort study from a university-affiliated fertility center. In total, 550 early miscarriage patients who conceived through IVF/intracytoplasmic sperm injection (ICSI) after receiving the GnRH-ant or GnRH-a long protocol were analyzed to compare aneuploidy rates in early aborted tissues. To compare aneuploidy rates in blastocysts, 404 preimplantation genetic testing for aneuploidy (PGT-A) cycles with the GnRH-ant protocol or GnRH-a long protocol were also analyzed.
RESULTS: For early miscarriage patients who conceived through IVF/ICSI, compared to the GnRH-a long protocol group, the GnRH-ant protocol group had a significantly higher rate of aneuploidy in early aborted tissues (48.51% vs. 64.19%). Regarding PGT-A cycles, the rate of blastocyst aneuploidy was significantly higher in the GnRH-ant protocol group than the GnRH-a long protocol group (39.69% vs. 52.27%). After stratification and multiple linear regression, the GnRH-ant regimen remained significantly associated with an increased risk of aneuploidy in early aborted tissues and blastocysts [OR (95% CI) 1.81 (1.21, 2.71), OR (95% CI) 1.65 (1.13, 2.42)]. Furthermore, the blastocyst aneuploidy rate in the GnRH-ant protocol group was significantly higher but only in young and normal ovarian responders [OR (95% CI) 5.07 (1.99, 12.92)].
CONCLUSIONS: Compared to the GnRH-a long protocol, the GnRH-ant protocol is associated with a higher aneuploidy rate in early aborted tissues and blastocysts. These results should be confirmed in a multicenter, randomized controlled trial.