反复植入失败患者试管婴儿计划的活产预测。

IF 2.1 4区医学 Q2 OBSTETRICS & GYNECOLOGY

European journal of obstetrics, gynecology, and reproductive biology Pub Date : 2024-11-05 DOI:10.1016/j.ejogrb.2024.11.007

Oleksandra Kozyra , Mykhailo Medvediev , Andrea Tinelli

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引用次数: 0

摘要

背景：当优质胚胎植入子宫，但通过超声波观察到宫内孕囊时，妊娠并未确立，这就是所谓的 "植入失败"。发生两次以上着床失败的病例被定义为复发性着床失败（RIF）。在不孕症治疗的这一阶段，需要进行额外的检测，以避免在今后的体外受精（IVF）过程中再次出现同样的结果：研究目的：该研究旨在评估胚胎移植个性化的预测价值，因为植入窗口研究与植入前基因检测相结合，对反复尝试植入的患者具有预测价值：简要介绍所采用的主要方法或治疗手段：这项前瞻性队列研究的样本为 93 名不孕妇女。关于治疗结果，该研究旨在评估患者特征、筛查指标和试管婴儿周期的几个特征（如移植胚胎的数量、质量和发育阶段）的预测重要性。采用的统计方法包括计算连续变量的中位数（Me）和四分位数间距（IQR）。Mann-Whitney U 检验用于区分不相关样本之间的差异，而分类变量则以绝对值和百分比值表示。皮尔逊卡方检验用于评估组间差异。利用进位和后向 Wald 方法进行逻辑回归，以确定与二元结果之间的关联：结果：整合个体化胚胎移植和植入前基因检测（PGT）后，复发性植入失败（RIF）患者的活产几率显著提高了 3.4 倍，统计学意义为 p = 0.026。相比之下，仅使用 PGT 可将活产概率提高 1.5 倍；但这一结果并无统计学意义（p = 0.439）。根据我们的研究结果，RIF 患者的活产预测模型定义如下：活产概率 = 1.936 + [如果使用 PGT-A 胚胎移植，则为 1.014] + [如果根据幸福指数（WI）定制子宫内膜准备，则为 1.742] [如果使用 PGT-A 胚胎移植，则为 1.014] + [如果根据幸福指数（WI）定制子宫内膜准备，则为 1.742] + [如果使用 PGT-A 胚胎移植，则为 1.860- 结论：结论：对于 RIF 患者来说，确定植入窗 (IW) 和胚胎 PGT 是实现活产的有效方法。

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Predictions of live birth in IVF programs of patients with recurrent implantation failure

Background

When a high-quality embryo is implanted into the uterus, but the pregnancy is not established as shown by the ultrasound visualization of an intrauterine gestational sac, this is known as “implantation failure.” Cases when more than two times implantation failure occurred was defined as recurrent implantation failure (RIF). Additional testing is done at this stage of infertility treatment to avoid a repeat of the same result with a future in vitro fertilization (IVF) effort.

Aim of the study

The study aimed to evaluate predictive value of using embryo transfer personalization because of the implantation window study in combination with preimplantation genetic testing in patients with recurrent implantation attempts.

Methods

Briefly describe the main methods or treatments applied: Ninety-three infertile women make up the sample for this prospective cohort study. In regard to treatment results, the study intends to assess the predictive importance of patient characteristics, screening indicators, and several features of IVF cycles, such as the quantity, quality, and developmental stage of the transferred embryos. Statistical methods employed include the calculation of the median (Me) and interquartile range (IQR) for continuous variables. The Mann-Whitney U test was used to discern differences between unrelated samples, while categorical variables were presented as absolute and percentage values. The Pearson’s Chi-squared test assessed differences between groups. Logistic regression, utilizing both enter and backward Wald methods, was applied to establish associations with binary outcomes.

Results

The integration of individualized embryo transfer and preimplantation genetic testing (PGT) significantly enhanced the likelihood of live births by 3.4 times in patients experiencing recurrent implantation failure (RIF), with a statistical significance of p = 0.026. In contrast, employing PGT alone increased the probability of live births by 1.5 times; however, this result was not statistically significant (p = 0.439). The predictive model for live birth in patients with RIF, based on our study findings, is defined as follows: the probability of live birth = 1.936 + [1.014 if PGT-A embryos are utilized for transfer] + [1.742 if endometrial preparation is tailored according to the Wellbeing Index (WI)] − [1.860 in cases of secondary infertility] − [1.891 when a male factor is involved].

Conclusions

The determination of the implantation window (IW) and PGT of the embryo are efficient methods of live birth achievement for patients with RIF.

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来源期刊

European journal of obstetrics, gynecology, and reproductive biology 医学-妇产科学

CiteScore

4.60

自引率

3.80%

发文量

898

审稿时长

8.3 weeks

期刊介绍： The European Journal of Obstetrics & Gynecology and Reproductive Biology is the leading general clinical journal covering the continent. It publishes peer reviewed original research articles, as well as a wide range of news, book reviews, biographical, historical and educational articles and a lively correspondence section. Fields covered include obstetrics, prenatal diagnosis, maternal-fetal medicine, perinatology, general gynecology, gynecologic oncology, uro-gynecology, reproductive medicine, infertility, reproductive endocrinology, sexual medicine and reproductive ethics. The European Journal of Obstetrics & Gynecology and Reproductive Biology provides a forum for scientific and clinical professional communication in obstetrics and gynecology throughout Europe and the world.