与辅助生殖技术孕育的后代单卵双胞胎相关的风险因素。

IF 8.3 Q1 OBSTETRICS & GYNECOLOGY
Human reproduction open Pub Date : 2023-09-14 eCollection Date: 2023-01-01 DOI:10.1093/hropen/hoad035
Na Chen, Jingyu Li, Yexing Li, Yiyuan Zhang, Jiarong Li, Jie Gao, Jingmei Hu, Linlin Cui, Zi-Jiang Chen
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引用次数: 0

摘要

研究问题:通过辅助生殖技术(ART)受孕的后代中,影响单卵(MZ)双胞胎发生的因素是什么?简要回答:父母年龄、新鲜胚胎与冷冻胚胎的移植以及胚泡的等级都与ART后代的MZ配对有关。已知情况:通过ART受孕的后代患MZ双胞胎的风险显著增加,这可能是由于不孕人群的特点。本研究的目的是探讨ART后单卵(MZ)双胞胎的发生率,并阐明MZ双胞胎的危险因素。研究设计规模持续时间:共有255对单卵双胞胎参与了这项队列研究,然后以1:4的比例随机与单卵双胞胎配对(对照组为1020对)。所有的后代都是通过单胚胎移植受孕的。参与者/材料设置方法:收集的数据分为以下三个方面进行分析:不育群体的特征、配子或胚胎操作以及与胚胎发育相关的因素。主要结果和偶然性的作用:MZ双胞胎的发生率为1.638%(15例中有255例) 567例单胚胎移植后妊娠)。与单胎分娩相比,冷冻胚胎移植率显著降低(FET;78.0%vs 86.1%P = 0.002)。在新鲜ET中,MZ双胞胎组的胚泡转移率高于对照组(92.9%vs 75.4%,P = 0.005)。我们还发现,在滋养外胚层(TE)发育、内细胞质量+TE发育和“优质”胚胎分类方面,某些级别的胚泡与MZ孪晶的发生率有关(P = 0.025,P = 0.012,P = 0.020)。Logistic回归分析显示,较高的父亲年龄(优势比(OR)) = 0.94,95%CI = 0.89-1.00,P = 0.029)和FET(OR = 0.48,95%CI = 0.33-0.68,P = 0.001)可能是防止MZ孪晶的保护因素。然而,较高的产妇年龄(OR = 1.07,95%CI = 1.01-1.13,P = 0.027)和胚泡转移(OR = 4.31195%CI = 1.46-12.73,P = 0.008)似乎与MZ孪晶的风险增加有关。在胚泡转移中,C级TE可能是防止MZ孪晶的保护因子(B:OR = 1.90,95%CI = 1.18-3.07,P = 0.009;A: 或 = 1.58,95%CI = 0.93-2.67,P = 0.089)。注意的局限性原因:首先,我们对MZ双胞胎的定义是基于单胚胎移植(SET)后双胞胎的出生,而不是妊娠早期的超声检查。其次,两组的父母特征是同质的,因此很难发现不育因素与MZ双胞胎的发病率之间的任何关联。研究结果的更广泛含义:对MZ结对风险因素的多方面分析为高危人群的临床干预提供了一些信息。研究资助/利益竞争:本研究得到了国家重点技术研究与发展计划(2022YFC2704404)、中国医学科学院医学科学创新基金(2021-I2M-5-001)、山东省泰山学者青年专家计划(tsqn201909195)、基础科学中心计划(31988101)、,山东省重点研发计划项目(2020ZLYS02)。所有作者都没有利益冲突需要声明。试用注册号:不适用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk factors associated with monozygotic twinning in offspring conceived by assisted reproductive technology.

Study question: What are the factors influencing the occurrence of monozygotic (MZ) twins in offspring conceived by assisted reproductive technology (ART)?

Summary answer: Parental ages, the transfer of fresh versus frozen embryos, and the grade of blastocysts are all related to MZ twinning in ART offspring.

What is known already: Offspring conceived by ART have significantly increased risk of MZ twins, which may be due to the characteristics of the infertile population. The objective of this study was to explore the incidence of monozygotic (MZ) twins after ART and to clarify the risk factors for MZ twinning.

Study design size duration: A total of 255 monozygotic twins were enrolled in this cohort study, and then matched with singletons at a ratio of 1:4 randomly (with 1020 in the control group). All offspring were conceived by single embryo transfer.

Participants/materials setting methods: The collected data were divided into the following three aspects for analysis: characteristics of the infertile population, gamete or embryo manipulations, and factors related to embryo development.

Main results and the role of chance: The incidence of MZ twins was 1.638% (255 out of 15 567 pregnancies after single embryo transfers). Compared to singleton births, a significantly lower rate of frozen embryo transfers (FET; 78.0% vs 86.1% P = 0.002) was seen amongst the MZ twins. Amongst fresh ETs, the rate of blastocyst transfers in the MZ twins group was higher compared to that in the control group (92.9% vs 75.4%, P = 0.005). We also found that certain grades of blastocysts in terms of trophectoderm (TE) development, inner cell mass + TE development and the classification of 'top-quality' embryos were associated with the incidence of MZ twinning (P = 0.025, P = 0.012, P = 0.020, respectively). Logistic regression analysis revealed that higher paternal age (odds ratio (OR) = 0.94, 95% CI = 0.89-1.00, P = 0.029) and FET (OR = 0.48, 95% CI = 0.33-0.68, P = 0.001) may be protective factors against MZ twinning. However, higher maternal age (OR = 1.07, 95% CI = 1.01-1.13, P = 0.027) and the transfer of blastocysts (OR = 4.31, 95% CI = 1.46-12.73, P = 0.008) appeared to be associated with an increased risk of MZ twinning. Amongst blastocyst transfers, a C grade TE may be protective factor against MZ twinning (B: OR = 1.90, 95% CI = 1.18-3.07, P = 0.009; A: OR = 1.58, 95% CI = 0.93-2.67, P = 0.089).

Limitations reasons for caution: First, our definition of MZ twins was based on twins' birth after single embryo transfers (SET), rather than ultrasound examination during early pregnancy. Second, the parental characteristics of the two groups were homogenous, so it was difficult to find any associations between infertility factors and the incidence of MZ twins.

Wider implications of the findings: This multifaceted analysis of the risk factors for MZ twinning provides some information for clinical interventions in high-risk populations.

Study funding/competing interests: This study was supported by the National Key Technology Research and Developmental Program of China (2022YFC2704404), CAMS Innovation Fund for Medical Sciences (2021-I2M-5-001), Taishan Scholars Program for Young Experts of Shandong Province (tsqn201909195), the Basic Science Center Program (31988101), and the Shandong Provincial Key Research and Development Program (2020ZLYS02). All authors have no conflicts of interest to declare.

Trial registration number: N/A.

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