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IF 6.6 1区医学 Q1 OBSTETRICS & GYNECOLOGY

Fertility and sterility Pub Date : 2024-12-11 DOI:10.1016/j.fertnstert.2024.12.006

David Huang, Justina Hyunjii Cho, Michael Fanton, Eleni Jaswa, Marcelle I Cedars, Mitchell P Rosen

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引用次数: 0

摘要

目的根据卵母细胞年龄、形态和/或倍性进行调整后，研究来自不同卵泡群的囊胚是否具有不同的植入率：学术中心接受一个或多个周期的自体卵巢刺激和体外受精/卵胞浆内单精子注射，然后选择性进行单个冷冻囊胚移植的患者：卵泡队列的囊胚进展率；定义为膨大囊胚、非整倍体囊胚、第 5 天囊胚或第 5 天非整倍体囊胚的总数除以 2 代核（2PN）合子的数量：结果：共对 4292 个囊胚从卵泡群起源到 eSET 后的结果进行了跟踪。研究对象的平均年龄（± 标准差）为 36.2±3.6 岁。每个队列中卵母细胞和2PN合子的中位数（四分位数间距，IQR）分别为17（12-24）和11（8-16）。每个队列的总膨大囊胚数和第 5 天囊胚数的中位数（IQR）分别为 6（4-9）和 2（1-4）。非整倍体植入前基因检测（PGT-A）使用率为 63.0%。总的非整倍体囊胚和第 5 天非整倍体囊胚的中位数（IQR）分别为 2（1-4）和 1（0-2）。总囊胚进展率中位数（IQR）为 60.0%（43.5-75.0%），优倍囊胚进展率为 21.4%（13.3-33.3%），第 5 天囊胚进展率为 20.0%（8.7-35.2%），第 5 天优倍囊胚进展率为 9.1%（0.0-18.2%）。所有囊胚进展参数均与年龄增长成反比。多变量混合效应逻辑回归分析显示，调整卵母细胞年龄、取卵数量、胚胎形态和 PGT-A 状态后，囊胚总体进展与年龄呈正相关（调整后 OR 1.04 [95% CI 1.01-1.08]，p=0.02）、第 5 天囊胚进展（调整 OR 1.05 [95% CI 1.01-1.09]，p=0.01）和第 5 天优倍囊胚进展（调整 OR 1.10 [95% CI 1.03-1.18]，p=0.01）与植入率之间呈正相关：结论：调整年龄、取卵卵母细胞、形态学和倍性状态后，囊胚进展率高的卵泡群的囊胚与囊胚进展率低的卵泡群的囊胚相比，具有更高的植入潜力。这一观察结果表明了队列效应的存在，并为胚胎植入潜力方面的患者咨询提供了有价值的信息，而不仅仅是类倍体/形态学方面的信息。

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A blastocyst's implantation potential is linked to its originating oocyte cohort's blastulation rate: evidence for a cohort effect.

Objective: To investigate if blastocysts originating from different follicular cohorts have variable implantation rates, adjusted for oocyte age, morphology and/or ploidy DESIGN: Retrospective cohort SETTING: Academic center SUBJECTS: Patients who underwent one or more cycles of autologous ovarian stimulation and in vitro fertilization/intracytoplasmic sperm injection, followed by elective single frozen blastocyst transfer EXPOSURE: Blastocyst progression rate of a follicular cohort; defined as the total number of expanded blastocyst, euploid blastocyst, Day 5 blastocyst, or Day 5 euploid blastocyst(s) divided by the number of 2 pronuclei (2PN) zygote(s) MAIN OUTCOME MEASURES: Implantation, defined as serum human chorionic gonadotropin >5mIU/ml following elective single embryo transfer (eSET) RESULTS: A total of 4,292 blastocysts were tracked from their follicular cohort origin to their outcome following eSET. The mean age±standard deviation of the study population was 36.2±3.6 years old. The median (interquartile range; IQR) number of oocytes and 2PN zygotes per cohort was 17 (12-24) and 11 (8-16), respectively. The median (IQR) number of total expanded blastocysts and Day 5 blastocysts per cohort was 6 (4-9) and 2 (1-4), respectively. Preimplantation genetic testing for aneuploidy (PGT-A) utilization rate was 63.0%. The median (IQR) number of total euploid blastocysts and Day 5 euploid blastocysts were 2 (1-4) and 1 (0-2), respectively. Median (IQR) overall blastocyst progression rate was 60.0% (43.5-75.0%), euploid blastocyst progression rate 21.4% (13.3-33.3%), Day 5 blastocyst progression rate 20.0% (8.7-35.2%), and Day 5 euploid blastocyst progression rate 9.1% (0.0-18.2%). All blastocyst progression parameters inversely correlated with increasing age. Multivariable mixed-effects logistic regression analyses, adjusting for oocyte age, number of oocytes retrieved, embryo morphology, and PGT-A status, showed a positive association between overall blastocyst progression (adjusted OR 1.04 [95% CI 1.01-1.08], p=0.02), Day 5 blastocyst progression (adjusted OR 1.05 [95% CI 1.01-1.09], p=0.01), and Day 5 euploid blastocyst progression (adjusted OR 1.10 [95% CI 1.03-1.18], p=0.01) and implantation rates.

Conclusions: Adjusting for age, oocytes retrieved, morphology, and ploidy status, blastocysts from follicular cohorts with high blastocyst progression rates demonstrate superior implantation potential compared to those from cohorts with lower blastocyst progression rates. This observation suggests the presence of a cohort effect, and offers valuable information for patient counseling on an embryo's implantation potential beyond ploidy/morphology.

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来源期刊

Fertility and sterility 医学-妇产科学

CiteScore

11.30

自引率

6.00%

发文量

1446

审稿时长

31 days

期刊介绍： Fertility and Sterility® is an international journal for obstetricians, gynecologists, reproductive endocrinologists, urologists, basic scientists and others who treat and investigate problems of infertility and human reproductive disorders. The journal publishes juried original scientific articles in clinical and laboratory research relevant to reproductive endocrinology, urology, andrology, physiology, immunology, genetics, contraception, and menopause. Fertility and Sterility® encourages and supports meaningful basic and clinical research, and facilitates and promotes excellence in professional education, in the field of reproductive medicine.