目标:在当代社会,社会活跃的女性越来越多地为以后的生活计划生育。高龄患者的生育结果,即使是捐卵,通常由于子宫内膜老化而不理想。复发性着床失败(RIF)是辅助生殖技术(ART)的核心问题之一。尤其是高龄患者。高品质,整倍体胚胎以及胚胎期与子宫内膜内膜之间的同步对于积极结局至关重要。该研究旨在根据具有挑战性生殖史的高龄患者的子宫内膜容受性分析(ERA),通过个性化胚胎移植(pET)改善ART结果。和RIF通过利用,供体卵母细胞和胚胎非整倍性(PGT-A)的植入前遗传测试。
方法:随机,2020年至2023年进行了对照观察性随访研究。在获得知情同意后,选择RIF患者320例。根据随机化原则的一致应用,将患者分为研究组和对照组。对照组2单独选择。研究组包括接受PGT-A和ERA的患者,35-45岁,平均年龄为40.5±3.7岁。对照组1包括接受PGT-A的患者,35-45岁,平均年龄为40±4.2岁。对照组2包括接受PGT-A和ERA的患者,年龄小于35岁,平均年龄31.6±2.2岁。
结果:结果表明,ERA可以改善高龄患者的植入和妊娠结局,特别是那些有RIF的。研究组妊娠率明显高于对照组(77.9%),与对照组1(57.6%)相比(p=0.0007),与对照组2(77.3%)相比无显着差异(p=0.94)。研究组的种植率(54.1%)高于对照组1(39.4%)(p=0.0009),研究组与对照2组之间无显著差异(50%,p=0.87)。研究组活产率也较高(71.3%),与对照组1相比(39.4%)(p<0.0001)。研究组与对照2组差异无统计学意义(65.9%,p=0.50)。
结论:由ERA指导的pET可显著改善妊娠,植入,以及具有挑战性生殖史的高龄患者的活产率。在ERA指导下,pET提供的ART结局在高龄患者和年轻患者之间没有显著差异.
OBJECTIVE: In contemporary society, socially active women are increasingly planning their fertility for later in life. The fertility outcomes for advanced-age patients, even with egg donation, are often suboptimal due to endometrial aging. Recurrent implantation failure (RIF) is one of the core problems for assisted reproductive technology (ART), especially for advanced-age patients. High-quality, euploid embryos and synchronization between the embryonic stage and the uterine endometrial lining are crucial for positive outcomes. The study aims to improve ART outcomes with personalized embryo transfer (pET) according to endometrial receptivity analysis (ERA) in advanced-age patients with challenging reproductive histories, and RIF by utilizing, donor oocytes and preimplantation genetic testing for aneuploidy (PGT-A) for embryo testing.
METHODS: A randomized, controlled observational follow-up study was conducted from 2020 to 2023. After obtaining informed consent, 320 patients with RIF were selected. Patients were allocated into the study group and control group 1 based on consistent application of randomization principles, while control group 2 was selected separately. The study group included patients undergoing PGT-A and ERA, aged 35-45 years, with a mean age of 40.5±3.7 years. Control group 1 comprised patients undergoing PGT-A, aged 35-45 years, with a mean age of 40±4.2 years. Control group 2 consisted of patients undergoing PGT-A and ERA, aged less than 35 years, with a mean age of 31.6±2.2 years.
RESULTS: Results suggest that ERA may improve implantation and pregnancy outcomes in advanced-age patients, particularly those with RIFs. The pregnancy rate was significantly higher in the study group (77.9%), compared to control group 1 (57.6%) (p=0.0007), and no significant difference compared to control group 2 (77.3%) (p=0.94). The implantation rate was higher in the study group (54.1%) than in control group 1 (39.4%) (p=0.0009), and there was no significant difference between the study group and control group 2 (50%, p=0.87). The live birth rate was also higher in the study group (71.3%), compared to control group 1 (39.4%) (p<0.0001). There were no significant differences between the study group and control group 2 (65.9%, p=0.50).
CONCLUSIONS: pET guided by ERA significantly improves pregnancy, implantation, and live birth rates in advanced-age patients with challenging reproductive histories. pET provides ART outcomes with no significant difference between advanced-age patients and younger patients with pET guided by ERA.