平衡易位携带者性别对复发性流产夫妇胚胎移植结局的影响

Influence of the gender of reciprocal translocation carrier on the clinical outcomes of couples with recurrent miscarriage

目的分析因染色体平衡易位导致复发性流产(recurrent miscarriage,RM)的夫妇中,携带者性别对正常/平衡囊胚率(可移植囊胚率)及活产结局的影响。方法回顾性病例分析2012年1月至2018年12月期间在北京大学第三医院生殖医学中心就诊的携带平衡易位的RM夫妇的第一个刺激周期的临床资料,所有周期均进行胚胎移植前染色体结构重排检测(preimplantation genetic testing for chromosomal structural rearrangements,PGT-SR),比较不同性别携带者一个完整周期的妊娠结局。结果研究纳入247个刺激周期,均为一方携带,女性携带者136例,男性携带者111例。每移植周期临床妊娠率为47.64%(91/191),每移植周期活产率为43.98%(84/191),累积活产率为34.71%(84/242),周期取消率为38.87%(96/247)。女方平衡易位携带者的囊胚形成率[31.42%(427/1359)]低于男性携带者[36.44%(379/1040),P=0.010];女方平衡易位携带的夫妇获得的可移植囊胚率[31.85%(136/427)]与男方平衡易位携带者的夫妇[36.15%(137/379)],差异无统计学意义(P=0.198),囊胚数是患者获得活产的保护因素[OR(95%CI)=1.243(1.002~1.542),P=0.047]。结论女方平衡易位携带者的囊胚形成率低于男方平衡易位携带者,平衡易位携带者性别对可移植囊胚率没有影响。PGT-SR后携带者的性别不影响累积活产结局,需要根据患者获得活产所需的刺激周期数来评估携带者性别对妊娠结局的整体影响。

Objective To analyze the influence of carrier gender on normal/balanced blastocyst rate(transferable blastocyst rate)and live birth outcome in couples with recurrent miscarriage(RM)due to reciprocal translocation.Methods The clinical data of the first stimulated cycle of RM couples carried with the reciprocal translocation were retrospectively analyzed.Preimplantation genetic testing for chromosomal structural rearrangements(PGT-SR)were performed in all stimulated cycles.All patients were treated at the Reproductive Medicine Center of Peking University Third Hospital from January 2012 to December 2018.The pregnancy outcome of a full cycle was compared among carriers of different genders.Results Totally 247 stimulated cycles were included.Only one partner of couples was the carrier including 136 female carriers and 111 male carriers.The clinical pregnancy rate per transfer cycle was 47.64%(91/191),the live birth rate per transfer cycle was 43.98%(84/191).The cumulative live birth rate(multiple live birth)was 34.71%(84/242),and the cycle cancellation rate was 38.87%(96/247).The blastocyst formation rate of female carriers with reciprocal translocation[31.42%(427/1359)]was lower than that of male carriers[36.44%(379/1040),P=0.010].There was no statistically difference between the transferable blastocyst rate of female carriers with reciprocal translocation[31.85%(136/427)]and that of couples of male carriers[36.15%(137/379),P=0.198].The number of blastocysts was a protective factor for achieving a live birth[OR(95%CI)=1.243(1.002-1.542),P=0.047].Conclusion The blastocyst formation rate was lower in female reciprocal translocation carriers than in male carriers.The gender of reciprocal translocation carriers had no effect on transferable blastocyst rate.The gender of the carrier did not affect the cumulative live birth outcome after PGT-SR.The overall impact of the carrier's gender on pregnancy outcome should be evaluated according to the number of stimulation cycles required for the patient to achieve a live birth.