Preimplantation diagnosis for aneuploidies in patients undergoing in vitro fertilization with a poor prognosis:: identification of the categories for which it should be proposed
Preimplantation diagnosis for aneuploidies in patients undergoing in vitro fertilization with a poor prognosis:: identification of the categories for which it should be proposed
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DOI：
10.1016/s0015-0282(99)00377-5
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发表时间：
1999-11-01
影响因子：
6.7
通讯作者：
Munné, S
中科院分区：
文献类型：
--
作者：
Gianaroli, L;Magli, MC;Munné, S
目的：验证对预后不良的足月妊娠患者实施非整倍体着床前遗传学诊断与常规治疗程序相比是否具有优势。设计：随机对照研究。地点：意大利医学会生殖医学研究中心，博洛尼亚，意大利。患者：在262个刺激周期中，女性表现出以下不良预后指征：母亲年龄大于或等于36岁（n = 157），大于或等于3次IVF失败（n = 54），核型改变（n = 51）。在给予同意后，127名患者接受了非整倍体的植入前遗传学诊断，而135名对照组接受了辅助带孵化。干预：用荧光原位杂交技术对第3天胚胎的卵裂球进行染色体XY、13、14、15、16、18、21和22的分析。对对照组第3天胚胎进行辅助带孵化。主要观察指标：胚胎形态和染色体状况，移植胚胎数量，临床妊娠，着床率，流产率。结果：研究组717个胚胎荧光原位杂交分析，60%的胚胎染色体异常。99个周期平均移植2.3 +/- 0.9个整倍体胚胎，37例临床妊娠（37%），持续着床率22.5%；对照组126个周期，移植3.2 +/- 1.3个胚胎，34例临床妊娠（27%），持续着床率10.2%。结论：选择具有正常染色体补体的胚胎的优势对正在进行的着床率有直接影响，特别是在年龄大于或等于38岁的患者和核型改变的携带者中。[j] .中国农业科学(R); 1999; 32:837- 844。(C) 1999年，美国生殖医学学会。
Objective: To verify whether advantages can derive from the implementation of preimplantation genetic diagnosis for aneuploidy in patients with a poor prognosis of full-term pregnancy, compared with conventional treatment procedures.Design: A randomized, controlled study.Setting: Reproductive Medicine Unit of the Societa Italiana Studi Medicina della Riproduzione, Bologna, Italy.Patient(s): In a total of 262 stimulated cycles, women presented with the following poor-prognosis indications: maternal age of greater than or equal to 36 years (n = 157), greater than or equal to 3 previous IVF failures (n = 54), and an altered karyotype (n = 51). After giving consent, 127 patients underwent preimplantation genetic diagnosis for aneuploidy, whereas 135 controls underwent assisted zona hatching.Intervention(s): Analysis of chromosomes XY, 13, 14, 15, 16, 18, 21, and 22 was carried out with the fluorescence in situ hybridization technique in a blastomere biopsied from day 3 embryos. Assisted zona hatching was performed on day 3 embryos from the control group.Main Outcome Measure(s): Embryo morphology and chromosomal status, number of transferred embryos, clinical pregnancies, implantation rates, and abortions.Result(s): In the study group, 717 embryos were analyzed by fluorescence in situ hybridization, and 60% were chromosomally abnormal. A mean of 2.3 +/- 0.9 euploid embryos were transferred in 99 cycles, resulting in 37 clinical pregnancies (37%) and a 22.5% ongoing implantation rate;In the-control group, 126 cycles were performed with 3.2 +/- 1.3 embryos transferred, yielding 34 clinical pregnancies (27%) and a 10.2% ongoing implantation rate.Conclusion(s): The advantage of selecting embryos with a normal chromosome complement has an immediate impact on the ongoing implantation rate, especially in patients aged greater than or equal to 38 years and carriers of an altered karyotype. (Fertil Steril(R) 1999;72:837-44. (C) 1999 by American Society for Reproductive Medicine.).