PGT-A前冷冻囊胚活检与新鲜囊胚活检的比较分析

Comparative analysis of frozen embryo biopsy and fresh embryo biopsy before PGT-A

目的针对常规体外授精(IVF)/胞浆内单精子注射(ICSI)周期中有剩余冷冻囊胚,却反复种植失败、反复流产或流产物基因检测有异常的患者,探讨将其剩余冷冻囊胚活检并行染色体整倍体性检测以改善妊娠结局的可行性。方法研究分为两组,IVF/ICSI周期中冷冻囊胚活检的患者为冻胚活检组,胚胎植入前非整倍体遗传学检测(PGT-A)周期中新鲜囊胚活检的患者为鲜胚活检组。比较两组囊胚冷冻复苏后的存活率及妊娠结局。结果冻胚活检组(96例患者)与鲜胚活检组(104例患者)囊胚解冻后总的囊胚存活率比较,差异无统计学意义(96.5%vs 98.9%,P=0.211),移植后的胚胎着床率(61.9%vs 65.2%,P=0.630)和流产率(18.5%vs 18.3%,P=0.985)比较,差异均无统计学意义。冻胚活检组的胚胎整倍体率显著高于鲜胚活检组,差异有统计学意义(57.4%vs 48.6%,P=0.027)。结论冻胚活检法作为一种非常规的PGT-A活检方法安全有效。提高此类患者的胚胎利用率,可在一定程度上改善此类患者的妊娠结局。

Objective:To investigate the feasibility of using frozen blastocyst biopsy and PGT-A,to improve pregnancy outcome for patients suffering from repeated implantation failure,repeated abortion or abnormal genetic detection of abortion material during in vitro fertilization(IVF)/intracytoplasmic sperm Injection(ICSI)cycles.Methods:The study was divided into two groups.Patients with frozen blastocyst biopsy in IVF/ICSI cycle were in the frozen embryo biopsy group,and patients with fresh blastocyst biopsy in preimplantation genetic testing for aneuploidies(PGT-A)cycle were in the fresh embryo biopsy group.The blastocyst survival rate and pregnancy outcome were compared between the two groups.Results:There was no significant difference in the total blastocyst survival rate between the frozen embryo biopsy group(96 patients)and the fresh embryo biopsy group(104 patients)after blastocyst thawing(96.5%vs 98.9%,P=0.211).The embryo implantation rate(61.9%vs 65.2%,P=0.630)and abortion rate(18.5%vs 18.3%,P=0.985)were not statistically different between the two groups.However,the rate of euploidy embryos in the frozen embryo biopsy group was significantly higher than that in the fresh embryo biopsy group,the difference was statistically significant(57.4%vs 48.6%,P=0.027).Conclusions:As an unconventional PGT-A biopsy method,frozen embryo biopsy is safe and effective.It can improve the utilization rate of embryos in these patients and improve the pregnancy outcome of these patients to a certain extent.