| Objective:Recurrent spontaneous abortion(RSA)refers to two or more consecutive pregnancy losses.The disease affects 3-5% women.There are still a number of RSA couples who have experienced a series of examinations and evaluations but have not found the cause of abortion.In recent years,with the cytogenetic analysis of abortuses,more than 50% of abortions were found caused by abnormal chromosome.For the RSA patients,the(preimplantation genetic testing for aneuploidy,PGT-A)technology was recommended for choosing euploid embryo for implantation,so as to improve the clinical pregnancy rate and reduce the early abortion rate.However,there are many disputes about whether PGT-A is feasible for RSA patients.In this study,we compared the pregnancy outcomes of unexplained RSA patients with(Intra cytoplasmic sperm injection,ICSI)+ PGT-A therapy and routine IVF/ICSI treatment,to explore the effect of PGT-A on RSA patients with infertility,so as to provide the basis for the treatment of RSA.Methods: The clinical data of RSA patients in the reproductive center of Northwest women’s and children’s Hospital from January 2017 to May 2019 were analyzed retrospectively.Inclusion criteria:clinical pregnancy abortion ≥ 2 times accompanied by a normal sexual life without contraception for 1 year without pregnancy.Exclusion criteria:1.Chromosomal abnormality of both husband and wife;2.Abnormal anatomy of the genital tract;3.Endocrine metabolism disorder;4.Abnormality of immunology;5.Pre-thrombotic state;6.Genital tract infection;7.Male abnormal semen examination;8.High risk factors of abortion in the living environment of husband and wife;If the patients meet the above inclusion exclusion criteria,refer to the expert consensus on《preimplantation genetic diagnosis / screening technology》 in 2018,PGT-A can be used.According to whether the patients receiving assisted reproduction choose PGT-A,132 patients in PGT-A group and 564 patients in IVF/ICSI control group were included.The clinical pregnancy rate,abortion rate and live birth rate of the two groups were compared.Results: 1.Baseline characteristics: Compared with the control group,the female age of PGT-A group was lower than that of the control group(30.13±3.99 VS 32.39±3.84 P<0.001),the difference is statistically significant;The number of cycles with tubal infertility in the control group was higher than that in the PGT-A group(50.71% VS 39.39%P=0.019),the difference is statistically significant;There were no significant differences between the two groups in age of the male,abortion frequency,BMI of the female,BMI of the male,follicle number of the basal sinus,basal FSH value,basal LH value and basal E2value(P>0.05).2.Parameters of controlled ovarian stimulation and laboratory embryo development: There was no significant difference between the two groups in the time period of using Gn,the total amount of applied Gn,the hormone level on trigger day,the number of follicles >14mm,the number of oocytes retrieved,the rate of fertilization,the rate of cleavage,Day3 available embryo rate,the rate of Day3 good quality embryos,the rate of blastocysts formation(P>0.05).3.The results of chromosome aneuploidy detection in PGT-A group: a total of 469 embryos were biopsied,among them 452 embryos were successfully biopsied.The euploidy rate,aneuploidy rate,chimera rate and amplification failure rate were44.35%,49.47%,2.56% and 3.62%.PGT-A patients were divided into two age groups.The aneuploidy rate in patients with age ≥ 35 years old was higher than that of patients with age < 35 years old(56.92% vs 44.48% P=0.008),the difference is statistically significant.4.Pregnancy outcome: The clinical pregnancy rate(68.94% vs 44.33% P<0.001)and live birth rate(53.03% vs 31.91% P<0.001)of PGT-A group were higher than those of the control group,the difference were statistically significant,and the bortion rate was lower than that of the control group(23.08% vs 28% P>0.05),but there was no statistical significance;Logistic regression analysis shows: after adjusting the age of the female,the pregnancy rate and live birth rate of PGT-A group were still higher than those of the control group(P<0.001),the difference were statistically significant.The patients were divided into two groups according to their ages.The age of the female < 35 years old group: the clinical pregnancy rate(69.61% vs 57.24% P=0.029)of PGT-A group was higher than that of the control group,the difference was statistically significant,the live birth rate(55.88% vs 44.88% P>0.05)was higher than that of the control group and the abortion rate(19.72% vs 21.6% P>0.05)was lower than that of the control group,but there were no statistical significance.In the age of the female≥35 years old group,The clinical pregnancy rate(66.67% VS 31.32% P<0.001)and live birth rate(43.33% VS 18.86%P=0.022)of PGT-A group were higher than those of the control group,The difference were statistically significant,and the abortion rate was lower than that of the control group(35% VS 39.77% P>0.05),but there was no statistical significance;Because the PGT-A group was transplanted with single blastocyst,compared with control group’s single blastocyst transfer cycles,the pregnancy rate(68.94% vs 55.47% P=0.023)and live birth rate(53.03% vs 40.88% P=0.046)of PGT-A group were higher than those of control group,the difference were statistically significant,and the abortion rate was lower than that of control group(23.08% vs 26.32% P>0.05),but there was no statistical significance.Conclusion:1.ICSI+PGT-A can significantly improve the pregnancy rate and live birth rate of unexplained RSA patients with infertility compared with routine IVF/ICSI.2.According to the age group analysis: ICSI+PGT-A group can significantly improve the pregnancy outcome of the elderly patients with age≥35 years old.3.Compared with IVF / ICSI group’s single blastocyst transfer cycles,PGT-A group has significantly higher pregnancy rate and live birth rate.4.PGT-A can reduce the abortion rate of unexplained RSA patients with infertility,but compared with the control,the difference was not statistically significant. |
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