| Chapter 1:Analysis of pregnancy outcome after preimplantation genetic screening for patients with unexplained repeated implant failureObjective:To evaluate the clinical results of preimplantation genetic screening(PGS)in patients with unexplained recurrent implantation failure(uRIF).Methods:A total of 140 patients diagnosed as having uRIF were collected and 189 transfers after referral were analysed(95 circles in PGS group,94 circles in control group);72 patients who underwent PGS were included in the PGS group,while 68 non-PGS patients were included in the control group.All the subjects were divided into two subgroups by age(<35 years,>35 years),the clinical outcome were compared.Results:1.There was no significant difference in age,base FSH,E2 level,MII oocyte number,and endometrial thickness between the two groups(P>0.05).The number of previous transplantation failure cycles and the follicle stimulating days in PGS group were higher than those in the control group,but the number of embryos in each transplant was lower than that of the control group,the difference was statistically significant.2.The pregnancy outcome was compared between the PGS group and the control group,the implantation rate(P=0.001)and clinical pregnancy rate(P=0.045)in group PGS were significantly increased.There was no significant difference in the abortion rate,the live birth rate of first transfer,the cumulative clinical rate and the twin rate in the PGS group and the control group.3.In the pregnancy outcome of ≥35 years old group,the implantation rate(P = 0.003)and the clinical pregnancy rate(P = 0.027)in PGS group were higher than those in the control group,but there was no significant difference in abortion rate,ongoing pregnancy rate,live birth rate of first transfer,cumulative live birth rate between the two groups.4.In group<35 years old,there was no significant difference in implantation rate,clinical pregnancy rate,ongoing pregnancy rate,abortion rate,live birth rate of first transfer,and cumulative live birth rate between PGS group and control group.5.The pregnancy outcome of the patients in the PGS group,the ongoing pregnancy rate(P=0.023),the cumulative live birth rate(P=0.005)in<35 years old group higher than that of ≥ 35 years old group,the abortion rate(P=0.012)lower than the group of patients over 35 years old.There was no significant difference of pregnancy rate,live birth rate of first transfer and the implantation rate between the two groups.6.The pregnancy outcome of the patients in control group,pregnancy rate(P=0.017)and implantation rate(P=0.017)in the<35 years old group higher than that of ≥35 years old group.There was no significant difference in the abortion rate,live birth rate of first transfer,the cumulative live birth rate and the ongoing pregnancy rate between two groups.7.Preimplantation screening by PGS technology,174 the normal embryos and 121 abnormal embryos,the embryos abnormal rate of was 41.02%.Embryos abnormal rate was 52.33%in ≥ 35 years old patients and 36.36%in<35 years old,there was a significant difference in the embryos abnormal rate between the two groups.Conclusion:1.The patients of unexplained recurrent implantation failure treated by PGS technology,improve embryo implantation rate and clinical pregnancy rate of uRIF female older than 35 years old.2.<35 years old uRIF patients,PGS technology did not improve the outcome of pregnancy,the cause of young patients still need further study.3.In uRIF patients,with the growth of women’s age,the embryo abnormal rate in uRIF patients is also increased,and the embryo abnormal rate of uRIF in older women is significantly higher than that of young women.4.Because of the limitation of the sample numbers,case screening and technical application time,this study still needs to be followed up.Chapter2:Leukemia inhibitory factor,suppressor of cytokine signaling-3 and unexplained repeated implantation failure Related research.Purpose:To detect the contents of leukemia inhibitory factor and suppressor of cytokine signaling-3 in plasma of unexplained repeated implantation failure during ovulatory period,and provide some theoretical basis for the diagnosis and prevention of uRIF.Method:thirty-six women with uRIF in Center for Reproductive Medicine,Shandong University from December 2016 to October 2017 were enrolled in this study.Forty-five infertile patients were simultaneous taken as control.According to the cause of infertility,it was divided into the female factor group and the male factor group.The ELISA method was used to detect the contents of SOCS-3 and LIF in the plasma of three group patients during ovulatory period,and the SPSS 19.0 statistical software was used to analyze.Results:1.There were significant differences in content of LIF among uRIF group,the women factor group and the male factor group(P<0.01).The content of LIF in group uRIF was significantly lower than that of the female factor group and the male factor group,and the female factor group was slightly lower than the male factor group.2.There were significant differences in content of SOCS-3 among uRIF group,the women factor group and the male factor group(P<0.01).The uRIF group was significantly lower than the female factor group and the male factor group,and there was no significant difference between the latter two.Conclusions:1.The content of LIF in group uRIF was significantly lower than that of the women factor group and male factor group.It is suggested that with the increase of the number of implantation failure,the internal environment of the uterus also presents a trend of decline.Therefore,we can detect the content of LIF in plasma,predict the environment of endometrium,it has a certain guiding significance for the pregnancy outcome.2.The content of SOCS-3 in uRIF group was significantly lower than that of the women factor group and the male factor group,however,there was no significant difference in the content of SOCS-3 between the two groups of women factors and men factors,suggesting that the immune factors play an important role in the cause of uRIF.3.The mechanism of LIF and SOCS-3 in embryo implantation is discussed,which may provide a theoretical basis for improving clinical implantation rate and developing new type of clinical diagnosis and treatment. |
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