背景:非侵入性染色体筛查(NICS)和滋养外胚层活检植入前基因检测(TE-PGT)均用于胚胎倍性检测,然而,老年组NICS和TE-PGT的累积活产率(CLBR)尚未报告.这项研究旨在确定NICS和TE-PGT是否可以提高高龄产妇的累积活产率。
方法:共招募384对35-40岁的夫妇。患者被分为三组:NICS,TE-PGT,和卵胞浆内单精子注射(ICSI)。所有患者均接受冷冻单囊胚移植。NICS和TE-PGT组患者接受非整倍体筛查。
结果:与ICSI组相比,NICS和TE-PGT组的CLBR明显更高(27.9%vs.44.9%vs.51.0%,对于NICS和NICS,p=0.003ICSI,TE-PGT与ICSI)。NICS和TE-PGT组之间的临床结果没有显着差异。调整混杂因素,NICS和TE-PGT组的CLBR仍高于ICSI组(校正比值比(OR)3.847,95%置信区间(CI)1.939~7.634;校正OR3.795,95%CI1.981~7.270).此外,NICS组和TE-PGT组的累积妊娠损失率显著低于ICSI组(校正OR0.277,95%CI0.087~0.885;校正OR0.182,95%CI0.048~0.693).三组出生体质量差异无统计学意义(p=0.108)。
结论:在35-40岁的女性中,可以通过使用NICS和TE-PGT选择整倍体胚胎来增加CLBR。对于胚胎非整倍体高风险的老年妇女,NICS,其特点是安全性和非侵入性,可能会成为植入前遗传检测的替代选择。
BACKGROUND: Non-invasive chromosome screening (NICS) and trophectoderm biopsy preimplantation genetic testing for aneuploidy (TE-PGT) were both applied for embryo ploidy detection, However, the cumulative live birth rates (CLBR) of NICS and TE-PGT in older age groups have yet to be reported. This study aimed to ascertain whether NICS and TE-PGT could enhance the cumulative live birth rates among patients of advanced maternal age.
METHODS: A total of 384 couples aged 35-40 years were recruited. The patients were assigned to three groups: NICS, TE-PGT, and intracytoplasmic sperm injection (ICSI). All patients received frozen single blastocyst transfer. Patients in the NICS and TE-PGT groups underwent aneuploidy screening.
RESULTS: When compared to the ICSI group, the CLBR was significantly higher in the NICS and TE-PGT groups (27.9% vs. 44.9% vs. 51.0%, p = 0.003 for NICS vs. ICSI, p < 0.001 for TE-PGT vs. ICSI). There were no significant differences in the clinical outcomes between the NICS and TE-PGT groups. Adjusting for confounding factors, the NICS and TE-PGT groups still showed a higher CLBR than the ICSI group (adjusted odds ratio (OR) 3.847, 95% confidence interval (CI) 1.939 to 7.634; adjusted OR 3.795, 95% CI 1.981 to 7.270). Additionally, the cumulative pregnancy loss rates of the NICS and TE-PGT groups were significantly lower than that of the ICSI group (adjusted OR 0.277, 95% CI 0.087 to 0.885; adjusted OR 0.182, 95% CI 0.048 to 0.693). There was no significant difference in the birth weights of the three groups (p = 0.108).
CONCLUSIONS: In women 35-40 years old, the CLBR can be increased by selecting euploid embryos using NICS and TE-PGT. For elderly women at high risk of embryonic aneuploidy, NICS, characterized by its safety and non-invasive nature, may emerge as an alternative option for preimplantation genetic testing.