内膜准备方案对PGT-A患者首次整倍体单囊胚移植妊娠结局及产科结局的影响

Effects of different endometrial preparation regimens on pregnancy outcomes and obstetrical outcomes for first euploid single blastocyst transfer after PGT⁃A

目的探讨不同内膜准备方案对胚胎植入前非整倍体检测(preimplantation genetic testing for aneuploidies,PGT-A)后整倍体单囊胚移植妊娠结局及产科结局的影响。方法回顾性分析2015年9月至2021年7月期间于郑州大学第一附属医院生殖医学中心行PGT-A助孕后整倍体单囊胚移植患者的临床资料,根据内膜准备方案分为自然周期组(n=80)和激素替代周期组(n=259),比较两组患者妊娠结局及产科结局的差异,并通过二元logistic回归探究影响PGT-A患者妊娠结局及产科结局的影响因素,再将年龄分层进一步探究不同内膜准备方案的妊娠结局。结果与自然周期组相比,激素替代周期组优质囊胚率显著升高,但活产率降低、流产率升高(P<0.05),两组临床妊娠率比较差异无统计学意义(P>0.05)。激素替代周期剖宫产率和巨大儿发生率高于自然周期组,低体重儿发生率低于自然周期组,但差异无统计学意义(P>0.05)。二元logistic回归显示:女方年龄是流产的独立影响因素,女方年龄和囊胚发育天数是活产的独立影响因素(P<0.05),内膜准备方案并不是妊娠及产科结局的影响因素(P>0.05)。进一步分析结果显示:35岁以上患者,自然周期组的活产率显著高于激素替代周期组,而流产率显著低于激素替代周期组(P<0.05)。结论内膜准备方案并不影响PGT-A助孕后整倍体单囊胚移植患者的妊娠结局及产科结局。但在高龄患者中,采用自然周期方案可获得更高的活产率、更低的流产率。

Objective To explore the effects of different endometrial preparation regimens on the pregnancy and obstetrical outcomes of single euploid blastocyst transfer after preimplantation genetic testing for aneuploidies(PGT-A).Methods The clinical data on patients with single euploid blastocyst transfer after PGT-A in our center from September 2015 to July 2021 were analyzed retrospectively.According to the different preparation regimens,the patients were divided into a natural cycle group(n=80 cycles)and a hormone replacement cycle group(n=259 cycles).The differences of pregnancy and obstetrical outcomes between the two groups were com⁃pared.Binary logistic regression was used to explore the influencing factors of pregnancy and obstetrical outcomes after PGT-A.The pregnancy outcomes of different endometrial preparation regimens were further explored by age stratification.Results As compared with that in the natural cycle group,the rate of high-quality blastocyst was significantly higher in the hormone replacement cycle group,but the live birth rate was lower and the abortion rate was higher(P<0.05).There was no statistical difference in the clinical pregnancy rate between the two groups.The incidence of cesarean section and macrosomia was higher in the hormone replacement cycle group than that in the natural cycle group,while the rate of low birth weight was lower,but there were no significant differences(P>0.05).Binary logistic regression showed that female age was an independent influencing factor of abortion.Female age and the days of blastocyst development were independent influencing factors of live birth.However,endometrial prepa⁃ration regimen was not a factor affecting pregnancy and obstetrical outcomes(P>0.05).The results of further analysis showed that the live birth rate in the natural cycle group was significantly higher than that in the hormone replacement cycle group,while the abortion rate in the natural cycle group was significantly lower than that in the hormone replacement cycle group for female patients aged over 35(P<0.05).Conclusions The endometrial preparation regimens did not affect the pregnancy and obstetrical outcomes of patients receiving single euploid blas⁃tocyst transfer after PGT-A.However,in the older patients,the natural cycle regimen can obtain a higher live birth rate and a lower abortion rate.