胚胎植入前染色体非整倍体检测在不同适应证中的助孕结局分析  

Analysis of pregnancy outcome of preimplantation genetic testing for aneuploidy in cycles with different indications

作　　者：周海燕[1,2,3,4] 吴彩云[1,5,6] 陈大蔚 郝燕[1,5,6] 章志国 周平[1,3,4] Zhou Haiyan;Wu Caiyun;Chen Dawei;Hao Yan;Zhang Zhiguo;Zhou Ping(Dept of Obstetrics and Gynecology,The First Affiliated Hospital of Anhui Medical University,Hefei 230022;Dept of Obstetrics and Gynecology,Chaohu Affiliated Hospital of Anhui Medical University,Chaohu 238000;NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract,Anhui Medical University,Hefei 230022;Key Laboratory of Population Health Across Life Cycle,Anhui Medical University,Hefei 230022;Anhui Province Key Laboratory of Reproductive Health and Genetics,Anhui Medical University,Hefei 230022;Anhui Provincial Engineering Research Center of Biopreservation and Artificial Organs,Hefei 230022)

机构地区：[1]安徽医科大学第一附属医院妇产科,合肥230022 [2]安徽医科大学附属巢湖医院妇产科,巢湖238000 [3]国家卫生健康委配子及生殖道异常研究重点实验室,合肥230022 [4]出生人口健康教育部重点实验室,合肥230022 [5]生殖健康与遗传安徽省重点实验室,合肥230022 [6]安徽省生命资源保存与人工器官工程技术研究中心,合肥230022

出　　处：《安徽医科大学学报》2023年第4期687-692,共6页Acta Universitatis Medicinalis Anhui

基　　金：安徽省科技重大专项项目(编号:202003a07020012)。

摘　　要：目的 分析胚胎植入前染色体非整倍体检测(PGT-A)在不同适应证中的助孕结局。方法 回顾性分析PGT-A助孕的549对夫妻,按PGT-A适应证分6组,反复妊娠丢失(304例)、反复种植失败(57例)、高龄(38岁及以上,80例)、不良妊娠史(绒毛染色体三体或不良妊娠,24例)、男性因素不育(67例)、性染色体数目异常(17例),比较基本情况、获卵及胚胎活检情况、妊娠结局。结果 各组之间平均年龄、促性腺激素(Gn)使用天数差异有统计学意义(P<0.001)。各组之间平均获卵数、优质胚胎率、嵌合胚胎率、异常胚胎率、胚胎活检正常率及平均卵巢敏感性指数(OSI)差异有统计学意义(P=0.03、P<0.001、P=0.03、P<0.001、P<0.001、P<0.001);高龄组异常胚胎率在6组中最高,平均获卵数、平均OSI及胚胎活检正常率最低。6组每取卵周期临床妊娠率及持续妊娠率、累积妊娠率差异有统计学意义(P<0.001),6组每移植周期临床妊娠率及持续妊娠率、除男性因素不育组外其余5组之间累积妊娠率差异无统计学意义。结论 PGT-A可检出整倍体胚胎移植,提高妊娠效率;高龄人群有正常胚胎移植,也可获得较好的妊娠率,可能缩短其“抱婴回家”时间。同时,PGT-A可大幅提高因男性因素不育人群的妊娠结局。Objective To analyze the pregnancy outcome of preimplantation genetic testing for aneuploidy(PGT-A)in cycles with different indications.Methods The clinical information of 549 couples who underwent PGT-A were retrospectively analyzed.The cycles were divided into 6 groups according to the indication for PGT-A,namely:recurrent pregnancy loss group(n=304),repeated implantation failure group(n=57),advanced age group(≥38 years old,n=80),history of adverse pregnancy group(chorionic trisomy or adverse pregnancy,n=24),male factor infertility group(n=67),and abnormal sex chromosome number group(n=17).The basic information,the number of retrieved oocytes,embryo biopsy result and pregnancy outcome were compared among different indication groups.Results The average age and days of gonadotropin(Gn)used among the six groups were statistically different(P<0.001).The average number of retrieved oocytes,the rate of good-quality embryos,mosaic embryos,abnormal embryos and normal embryos,the average ovarian sensitivity index(OSI)among the six groups were statistically different(P=0.03,P<0.001,P=0.03,P<0.001,P<0.001,P<0.001).Advanced age group had the highest rate of abnormal embryos,the least average number of retrieved oocytes,the lowest OSI and the lowest rate of normal embryos.There were statistical differences in clinical pregnancy rate,ongoing pregnancy rate and cumulative pregnancy rate per oocyte retrieved cycle(P<0.001)among the six groups,but there were no statistical differences in clinical pregnancy rate,ongoing pregnancy rate per transfer cycle and cumulative pregnancy rate among the five groups except for the male factor infertility group.Conclusion PGT-A can detect euploid embryo to transfer thereby improving pregnancy efficiency.The advanced age women have normal embryo to transfer and can obtain a better pregnancy rate,which may shorten their time of“take-baby-home”.At the same time,PGT-A can significantly improve the pregnancy outcome of those with male factor infertility.

关 键 词：辅助生殖技术 胚胎植入前染色体非整倍体检测 高龄 男性因素不育 妊娠结局 

分 类 号：R715.5[医药卫生—妇产科学]