Association Between Gestational Trophoblastic Disease (GTD) History and Clinical Outcomes in in Vitro Fertilization/intracytoplasmic Sperm Injection (IVF/ICSI) Cycles
Association Between Gestational Trophoblastic Disease (GTD) History and Clinical Outcomes in in Vitro Fertilization/intracytoplasmic Sperm Injection (IVF/ICSI) Cycles
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妊娠滋养细胞疾病 (GTD) 病史与体外受精/胞浆内单精子注射 (IVF/ICSI) 周期临床结果之间的关联
DOI：
10.21203/rs.3.rs-649509/v1
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发表时间：
2021
影响因子：
4.4
通讯作者：
Na Kong
中科院分区：
文献类型：
--
作者：
Xinyu Cai;Mei Zhang;Chenyang Huang;Yue Jiang;Jidong Zhou;Manlin Xu;Guijun Yan;Haixiang Sun;Na Kong
背景：妊娠滋养细胞疾病（GTD）通常发生在育龄期的年轻女性。在接受GTD治疗后，86%的女性希望怀孕。由于GTD和治疗的影响以及患者的焦虑，大量夫妇转向辅助生殖技术（ART），特别是体外受精/卵胞浆内单精子注射（IVF/ICSI）。但很少有研究调查GTD病史是否会影响继发性不孕患者IVF/ICSI的结局以及它是如何发生的。方法：回顾性队列研究2016年1月1日至2020年12月31日在南京鼓楼医院生殖医学中心接受IVF/ICSI治疗的176例继发性不孕妇女，分析GTD病史对IVF/ICSI结局和活产率的影响。研究对象分为GTD组（44例有GTD病史的妇女）和对照组（132例无GTD病史的妇女）。对照组和研究组根据患者年龄、不孕持续时间、周期数和体重指数（BMI）按3：1的比例配对。我们评估了回收的卵母细胞和高级别胚胎，生化妊娠，流产，异位妊娠，分娩时的孕龄，分娩方式和活产率。结果：我们发现，与IVF/ICSI周期相关的活产率（34.1%比66.7%）显着降低，与GTD病史的患者相比，那些没有GTD病史。GTD组的生化妊娠率和流产率略高于对照组。此外，GTD组和对照组分娩时的胎龄存在差异（p<0.001），但分娩方式无差异（p=0.267）。此外，GTD组的废弃胚胎数量大于对照组（p=0.018），优质胚胎数量小于对照组（p=0.019）。GTD组子宫内膜厚度较薄（p<0.001）。结论：IVF/ICSI周期患者的GTD病史对活产率和分娩孕周有影响，可能与胚胎移植前子宫内膜较薄和子宫内膜容受性异常有关。
Background: Gestational trophoblastic disease (GTD) usually affects young women of childbearing age. After treatment for GTD, 86% of women wish to achieve pregnancy. On account of the impacts of GTD and treatments as well as patient anxiety, large numbers of couples turn to assisted reproductive technology (ART), especially in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). But few studies have investigated whether a history of GTD affects the outcomes of IVF/ICSI in secondary infertile patients and how it occurs. We investigate whether a history of GTD affects the IVF/ICSI outcomes and the live birth rates in women with secondary infertility.Methods: This retrospective cohort study enrolled 176 women with secondary infertility who underwent IVF/ICSI treatment at the reproductive medical center of Nanjing Drum Tower Hospital from January 1, 2016, to December 31, 2020. Participants were divided into the GTD group (44 women with GTD history) and control group (132 women without GTD history matched from 8318 secondary infertile women ). The control group and the study group were matched at a ratio of 3:1 according to patient age, infertility duration, number of cycles and body mass index (BMI). We assessed retrieved oocytes and high-grade embryos, biochemical pregnancy, miscarriage, ectopic pregnancy, gestational age at delivery, delivery mode and live birth rates.Result(s): We found a significantly reduced live-birth rate (34.1% vs 66.7%) associated with IVF/ICSI cycles in patients with a GTD history compared to those without a GTD history. The biochemical pregnancy and miscarriage rates of the GTD group were slightly higher than those of the control group. In addition, there was a difference in gestational age at delivery between the GTD and control groups (p<0.001) but no differences in the mode of delivery (p=0.267). Furthermore, the number of abandoned embryos in the GTD group was greater than that in the control group (p=0.018), and the number of good-quality embryos was less than that in the control group (p=0.019). The endometrial thickness was thinner (p<0.001) in the GTD group. Immunohistochemistry (IHC) showed abnormal endometrial receptivity in the GTD group.Conclusion(s): The GTD history of patients undergoing IVF/ICSI cycles had an impact on the live-birth rate and gestational age at delivery, which might result from the thinner endometrium and abnormal endometrial receptivity before embryo transfer.