囊胚形态与整倍体率及单整倍体囊胚移植妊娠结局的关系

目的基于胚胎植入前非整倍体检测技术(PGT-A),评估囊胚形态学分级与染色体倍性之间的关系,并进一步评估囊胚形态学分级对于预测单整倍体囊胚移植(SEBT)妊娠结局的有效性。方法回顾性分析2016年9月至2019年4月期间在西北妇女儿童医院生殖中心完成囊胚期滋养外胚层细胞活检的PGT-A周期的临床资料,并随访活产情况至2021年3月。根据活检囊胚的Gardner形态学评分将活检囊胚分为优质囊胚组(394枚囊胚)和非优质囊胚组(1191枚囊胚)。比较两组的整倍体率及两组中单整倍体囊胚解冻移植后的妊娠结局。结果PGT-A共完成380个周期,共活检囊胚1585枚,其中优质囊胚394枚,非优质囊胚1191枚。两组的一般资料比较无显著性差异(P>0.05)。优质囊胚组的整倍体率显著高于非优质囊胚组(45.18%vs.37.28%,P<0.05),非整倍体率、嵌合体率及质控不合格率显著低于非优质囊胚组(分别为45.69%vs.49.62%、6.35%vs.8.56%及2.79%vs.4.53%,P<0.05)。两组共解冻移植单整倍体囊胚329个周期,优质囊胚组119个周期,非优质囊胚组210个周期,优质囊胚组的HCG阳性率(78.15%vs.73.81%)、临床妊娠率(76.47%vs.67.62%)及活产率(66.39%vs.57.14%)均略高于非优质囊胚组,流产率(10.08%vs.10.47%)略低于非优质囊胚组,但两组间尚无显著性差异(P>0.05)。结论囊胚形态学评分与囊胚的整倍体率有关,评分为优质的囊胚整倍体率更高。但进行单整倍体囊胚移植时,囊胚形态学评分并不影响妊娠结局。

Relationship between blastocyst morphology and euploidy rate and pregnancy outcome of single euploid blastocyst transfer

Objective:To evaluated the relationship between blastocyst morphological score and chromosome ploidy based on preimplantation genetic testing for aneuploidy(PGT-A),and further evaluate the effectiveness of blastocyst morphological grading in predicting pregnancy outcome of single euploid blastocyst transfer(SEBT).Methods:The clinical data of PGT-A cycle with blastocyst trophoectoderm cell biopsy performed in the Reproductive Center of Northwest Women’s and Children’s Hospital from September 2016 to April 2019 and followed up until March 2021 were retrospectively analyzed.According to the Gardner morphological score of blastocysts biopsy,the blastocysts were divided into two groups:high-quality blastocyst group(n=394)and non-high-quality blastocyst group(n=1191).The euploidy rate and the pregnancy outcome of single euploid blastocyst after thawed and transferred were compared between the two groups.Results:A total of 380 cycles of PGT-A were completed,and 1585 blastocysts were biopsied,including 394 high-quality blastocysts and 1191 non-high-quality blastocysts.There was no significant difference in general data between the two groups(P>0.05).The euploidy rate(45.18%vs.37.28%)of the high-quality blastocyst group was significantly higher than that of the non-high-quality blastocyst group,and the aneuploidy rate(45.69%vs.49.62%),mosaic rate(6.35%vs.8.56%)and quality control failure rate(2.79%vs.4.53%)were significantly lower than those of the non-high-quality blastocyst group(P<0.05).There were 329 cycles with single thawed euploid blastocyst transfer including 119 high-quality blastocyst cycles and 210 non-high-quality blastocyst cycles.The positive HCG rate(78.15%vs.73.81%),clinical pregnancy rate(76.47%vs.67.62%)and live birth rate(66.39%vs.57.14%)in the high-quality blastocyst group were higher than those in the non-high-quality blastocyst group,and the abortion rate(10.08%vs.10.47%)was lower than the non-high-quality blastocyst group,but the difference was not significant(P>0.05).Conclusions:The blastocyst morphological score is related to the euploid rate of blastocysts,and the euploid rate of high-quality blastocyst is higher.However,when single euploid blastocyst was transferred,the blastocyst morphology score does not affect the pregnancy outcome after transplantation.