A new definition of recurrent implantation failure on the basis of anticipated blastocyst aneuploidy rates across female age
A new definition of recurrent implantation failure on the basis of anticipated blastocyst aneuploidy rates across female age
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DOI：
10.1016/j.fertnstert.2021.06.045
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发表时间：
2021-10-29
影响因子：
6.7
通讯作者：
Somigliana, Edgardo
中科院分区：
文献类型：
--
作者：
Ata, Baris;Kalafat, Erkan;Somigliana, Edgardo
目的：提出复发性着床失败的定义，解释女性年龄和预期囊胚整倍体率对累积着床率的影响。设计：数学建模。设置：不适用。患者：不适用。干预措施：根据已发表的各女性年龄类别的囊胚整倍性率，建立累积着床概率的数学模型。主要结果指标：假设不存在任何其他影响着床的因素，则达到 95% 累积着床概率所需的囊胚数量。结果：当移植胚胎的整倍体状态未知时（即，未进行非整倍体的植入前基因检测），我们的模拟显示，在七个囊胚移植之前，没有任何年龄类别能够达到至少一个胚胎植入的 95% 累积概率。对于老年患者来说，达到相同阈值所需的囊胚数量更高。例如，38 岁以上的女性需要移植 10 个以上未经测试的囊胚，才能使预测概率的上限达到 95% 的阈值。另一方面，如果假设整倍体囊胚的着床率为 55%，那么无论年龄如何，4 个囊胚就足以达到大于 95% 的累积概率。结论：术语“复发性植入失败”应该是指导进一步治疗的功能术语。我们建议，除非植入失败很可能是由胚胎非整倍体（植入失败的主要原因）以外的因素引起的，否则不应报告复发性植入失败。我们提出了一个新的定义，考虑了不同女性年龄类别的预期囊胚整倍体率、整倍体囊胚植入率以及植入累积概率的指定阈值。 （Fertil Sterile 2021；116:1320-7。(c) 2021 年，美国生殖医学会。）
Objective: To present a definition of recurrent implantation failure that accounts for the effects of female age and anticipated blastocyst euploidy rates on cumulative implantation rates. Design: Mathematical modeling. Setting: Not applicable. Patient(s): Not applicable. Intervention(s): Mathematical modeling of cumulative implantation probability on the basis of published blastocyst euploidy rates across categories of female age. Main Outcome Measure(s): The number of blastocysts required to achieve 95% cumulative implantation probability under the assumption of the absence of any other factor affecting implantation. Result(s): When the euploidy status of the transferred embryo is unknown (i.e., not subjected to preimplantation genetic testing for aneuploidies), our simulation shows that no age category reaches 95% cumulative probability of implantation of at least one embryo until after transfer of seven blastocysts. The number of blastocysts required to reach the same threshold is higher for older patients. For example, women older than 38 years require transfer of more than 10 untested blastocysts for the upper range of predictive probability to meet the threshold of 95%. On the other hand, if the implantation rate for a euploid blastocyst is assumed to be 55%, then 4 blastocysts are enough to reach a cumulative probability rate greater than 95%, regardless of age. Conclusion(s): The term "recurrent implantation failure"should be a functional term guiding further management. We suggest that recurrent implantation failure should not be called until implantation failure becomes reasonably likely to be caused by factors other than embryo aneuploidy, the leading cause of implantation failure. We propose a new definition that factors in anticipated blastocyst euploidy rates across categories of female age, euploid blastocyst implantation rate, and a specified threshold of cumulative probability of implantation. (Fertil Sterile 2021;116:1320-7. (c) 2021 by American Society for Reproductive Medicine.)