Therapeutic efficacy of the optimization of thyroid function, thrombophilia, immunity and uterine milieu (OPTIMUM) treatment strategy on pregnancy outcomes after single euploid blastocyst transfer in advanced age women with recurrent reproductive failure.

IF 2.7 3区医学 Q2 OBSTETRICS & GYNECOLOGY

Reproductive Medicine and Biology Pub Date : 2023-12-22 eCollection Date: 2023-01-01 DOI:10.1002/rmb2.12554

Keiji Kuroda, Takashi Horikawa, Azusa Moriyama, Yuko Ojiro, Satoru Takamizawa, Hideaki Watanabe, Tetsuo Maruyama, Shuko Nojiri, Koji Nakagawa, Rikikazu Sugiyama

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引用次数: 0

Abstract

Purpose: To clarify the efficacy of the OPtimization of Thyroid function, Thrombophilia, IMmunity and Uterine Milieu (OPTIMUM) treatment strategy on pregnancy outcomes after euploid blastocyst transfer in advanced age women with recurrent implantation failure (RIF) and/or recurrent pregnancy loss (RPL).

Methods: Between January 2019 and May 2022, 193 consecutive women aged ≥40 years with RIF and/or RPL received single euploid blastocyst transfer. Before embryo transfer, 127 women underwent RIF/RPL testing. Chronic endometritis was treated with mainly antibiotics, aberrant high Th1/Th2 cell ratios with vitamin D and/or tacrolimus, overt/subclinical hypothyroidism with levothyroxine, and thrombophilia with low-dose aspirin. We compared pregnancy outcomes in the women who did and did not receive the OPTIMUM treatment strategy.

Results: Women with RIF/RPL in the OPTIMUM group had significantly higher clinical pregnancy and livebirth rates than did those in the control group (clinical pregnancy rate of 71.7% and 45.5%, p < 0.001; livebirth rate of 64.6% and 39.4%, p = 0.001, respectively). However, preimplantation genetic testing for aneuploidy with and without OPTIMUM promoted low miscarriage rates with no significant difference between them (9.9%, and 13.3%, respectively; p = 0.73).

Conclusions: The OPTIMUM treatment strategy improved clinical pregnancy rates after single euploid blastocyst transfer; but not miscarriage rates.

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优化甲状腺功能、血栓性疾病、免疫和子宫环境（OPTIMUM）治疗策略对反复生殖失败的高龄产妇单倍体囊胚移植后妊娠结局的疗效。

目的：明确甲状腺功能、血栓性疾病、免疫和子宫环境优化（OPTIMUM）治疗策略对复发性着床失败（RIF）和/或复发性妊娠丢失（RPL）的高龄女性进行优倍囊胚移植后妊娠结局的疗效：方法：2019年1月至2022年5月，连续193名年龄≥40岁的RIF和/或RPL女性接受了单倍体囊胚移植。胚胎移植前，127 名女性接受了 RIF/RPL 检测。慢性子宫内膜炎主要用抗生素治疗，Th1/Th2 细胞比率异常高用维生素 D 和/或他克莫司治疗，明显/亚临床甲状腺功能减退用左甲状腺素治疗，血栓性疾病用小剂量阿司匹林治疗。我们比较了接受和未接受 OPTIMUM 治疗策略的女性的妊娠结局：OPTIMUM组RIF/RPL女性的临床妊娠率和活产率明显高于对照组（临床妊娠率分别为71.7%和45.5%，P = 0.001）。然而，使用 OPTIMUM 和不使用 OPTIMUM 进行胚胎植入前非整倍体基因检测的流产率都很低（分别为 9.9% 和 13.3%；P = 0.73）：OPTIMUM治疗策略提高了单倍体囊胚移植后的临床妊娠率，但并没有提高流产率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Reproductive Medicine and Biology Multiple-

CiteScore

5.70

自引率

5.90%

发文量

审稿时长

20 weeks

期刊介绍： Reproductive Medicine and Biology (RMB) is the official English journal of the Japan Society for Reproductive Medicine, the Japan Society of Fertilization and Implantation, the Japan Society of Andrology, and publishes original research articles that report new findings or concepts in all aspects of reproductive phenomena in all kinds of mammals. Papers in any of the following fields will be considered: andrology, endocrinology, oncology, immunology, genetics, function of gonads and genital tracts, erectile dysfunction, gametogenesis, function of accessory sex organs, fertilization, embryogenesis, embryo manipulation, pregnancy, implantation, ontogenesis, infectious disease, contraception, etc.