胚胎植入前遗传学检测技术联合个体化助孕前干预在高龄体外受精⁃胚胎移植患者中的应用效果

Effect of preimplantation genetic testing technology combined with individualized pre⁃pregnancy intervention on elderly patients undergoing in vitro fertilization⁃embryo transfer

目的探讨胚胎植入前遗传学检测(preimplantation genetic testing,PGT)技术联合个体化助孕前干预在高龄体外受精⁃胚胎移植(in vitro fertilization⁃embryo transfer,IVF⁃ET)患者中的应用效果,并分析高龄IVF⁃ET患者妊娠失败的相关因素。方法随机选取2023年1~6月于济宁医学院附属医院生殖医学科行IVF⁃ET助孕的100例高龄患者作为研究对象。依据不同干预方式分组,将30例单纯进行助孕前干预的患者纳入助孕前干预组,34例单纯进行PGT的患者纳入PGT组,36例PGT联合助孕前干预的患者纳入PGT+助孕前干预组。对比分析3组患者妊娠情况、卵子质量;并依据3组患者的妊娠情况将其分为妊娠成功组与妊娠失败组,经多元Logistic回归方程分析影响高龄IVF⁃ET患者妊娠结局的相关因素。结果3组患者年龄、体质量指数(BMI)、不孕年限、不良孕产史、促卵泡生成激素(FSH)、促黄体生成素(LH)、雌二醇(E_(2))、孕酮(P)、多胎妊娠率、异位妊娠率、流产率比较,差异无统计学意义(P>0.05);PGT+助孕前干预组临床妊娠率高于助孕前干预组(P<0.05);PGT+助孕前干预组获卵率、正常受精率、卵裂率、优质胚胎率均高于助孕前干预组和PGT组(P<0.05);100例高龄IVF⁃ET患者接受不同辅助生殖方式后临床妊娠成功62例,临床妊娠失败38例;妊娠成功组与妊娠失败组患者不孕年限、不良孕产史、促排方案方面差异无统计学意义(P>0.05),在年龄、BMI、获卵数、优胚数、移植胚胎数、内膜厚度、辅助生殖方式方面差异有统计学意义(P<0.05);年龄、BMI是高龄IVF⁃ET患者临床妊娠的危险因素(OR>1,P<0.05),获卵数、优胚数、移植胚胎数、内膜厚度、辅助生殖方式是高龄IVF⁃ET患者临床妊娠的保护因素(OR<1,P<0.05)。结论PGT技术联合个体化助孕前干预能有效提高高龄IVF⁃ET患者的临床妊娠率,降低流产率。

Objective To explore the application effect of preimplantation genetic testing(PGT)combined with individualized pre⁃pregnancy intervention in elderly patients undergoing in vitro fertilization⁃embryo transfer(IVF⁃ET),and to analyze the related factors of pregnancy failure in elderly IVF⁃ET patients.Methods 100 elderly patients undergoing IVF⁃ET assisted pregnancy in the department of reproductive medicine of the Affiliated Hospital of Jining Medical College from January 2023 to June 2023 were randomly selected as the research objects.According to different intervention methods,30 patients with pre⁃pregnancy intervention alone were included in the pre⁃pregnancy intervention group,34 patients with PGT alone were included in the PGT group,and 36 patients with PGT combined with pre⁃pregnancy intervention were included in the PGT+pre⁃pregnancy intervention group.The pregnancy and egg quality of the three groups were compared and analyzed.According to the pregnancy situation,the three groups of patients were divided into successful pregnancy group and failed pregnancy group,and the related factors affecting the pregnancy outcome of elderly IVF⁃ET patients were analyzed by multivariate Logistic regression.Results There was no significant difference in age,body mass index(BMI),years of infertility,adverse pregnancy history,follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E_(2)),progesterone,multiple pregnancy rate,ectopic pregnancy rate and abortion rate among the three groups(P>0.05).The clinical pregnancy rate in PGT+pre⁃pregnancy intervention group was higher than that in pre⁃pregnancy intervention group(P<0.05).The rate of getting eggs,normal fertilization,cleavage and high⁃quality embryos in PGT+pre⁃pregnancy intervention group were higher than those in PGT and pre⁃pregnancy intervention group(P<0.05).Among 100 elderly IVF⁃ET patients,62 cases were successful in clinical pregnancy and 38 cases failed in clinical pregnancy after receiving different assisted reproductive methods.There was no significant difference in the years of infertility,the history of poor pregnancy and promotion plan between the successful pregnancy group and the failed pregnancy group(P>0.05),but there were significant differences in age,BMI,number of eggs obtained,number of excellent embryos,number of transplanted embryos,intimal thickness,and assisted reproductive mode(P<0.05).Age and BMI were the risk factors of clinical pregnancy in elderly patients with IVF⁃ET(OR>1,P<0.05),while the number of eggs obtained,the number of excellent embryos,the number of transferred embryos,the thickness of intima and the assisted reproductive mode were the protective factors of clinical pregnancy in elderly patients with IVF⁃ET(OR<1,P<0.05).Conclusion PGT combined with individualized pre⁃pregnancy intervention can effectively improve the clinical pregnancy rate of elderly IVF⁃ET patients and reduce the abortion rate.