控制性促排期间使用促性腺激素累计用剂量对囊胚整倍体率的影响

Effect of cumulative dose of gonadotropin in controlled ovarian hyperstimulation on euploid rate of blastocyst

目的分析胚胎植入前非整倍体遗传学检测(PGT-A)患者行控制性促排期间使用外源性促性腺激素累计用量对于囊胚染色体整倍体率的影响。方法选取2018年10月至2020年7月武汉大学人民医院生殖医学中心诊治的63例PGT-A患者共计69个周期的临床资料进行回顾性分析。统计患者及配偶年龄、促性腺激素累计用量、不孕年限、不良妊娠次数等因素,比较不同因素组间获取囊胚整倍体率是否存在差异。采用二元Logistic回归分析年龄、不良妊娠次数、促性腺激素累计用量等因素与获得囊胚整倍体率的相关性。结果①不同患者年龄组间囊胚整倍体率比较,差异具有统计学意义(χ^(2)=12.031,P=0.001);不同配偶年龄组间囊胚整倍体率比较,差异无统计学意义(χ^(2)=3.552,P=0.059)。②不同不孕年限组间囊胚整倍体率比较,差异无统计学意义(χ^(2)=0.950,P=0.330)。③不同不良妊娠次数组间囊胚整倍体率比较,差异具有统计学意义(χ^(2)=4.986,P=0.026)。将上述相关因素纳入二元Logistic回归分析,结果显示,外源性促性腺激素累计用量与囊胚整倍体呈负性相关(P=0.020,OR=0.999,95%CI为0.998~1.000)。结论大剂量使用促性腺激素是获得胚胎整倍体率偏低的危险因素。

Objective To analyze the effect of the cumulative amount of gonadotropin on the euploidy rate of blastocyst in PGT-A patients undergoing controlled superstimulation.Methods The clinical data of 69 cycles of 63 PGT-A patients from October 2018 to July 2020 in the Department of Reproductive Medicine Center of Renmin Hospital of Wuhan University were collected.The age of the patients and their partners,gonadotropin dosage,duration of infertility and abnormal pregnancy frequency,and other factors were counted,and the difference of the acquisition rate of blastocyploidy among different groups was compared.Binary Logistic regression was used to analyze the correlation among duration of infertility,abnormal pregnancy frequency,the dose of gonadotropin and so on with euploidy rate of blastocyst.Results①Comparison of blastocyst euploidy rates between different groups divided by patients age was statistically significant ( χ^(2) = 12. 031,P = 0. 001);there was no statistically significant differencein blastocyst euploidy rates between the groups classified by different spouses age ( χ^(2) = 3. 552,P = 0. 059) .②There was no statistically significant difference in the euploidy rate of blastocysts between groups divided by infertilityduration ( χ^(2) = 0. 950,P = 0. 330) . ③Comparing the euploidy rate of blastocysts between groups with differentabnormal pregnancy frequency,the difference was statistically significant ( χ^(2)= 4. 986,P = 0. 026) . The abovementionedrelated factors are included in the binary logistic regression analysis,and the results reveal that the cumulativeamount of exogenous gonadotropin is negatively correlated with blastocyst euploidy ( P = 0. 020,OR = 0. 999,95%CI 0. 998-1. 000) . Conclusions Excessive use of gonadotropins is a risk factor for the low euploidy rate ofembryos.