卵巢早衰(38 years, FSH>10, AMH<1), 胚胎染色體異常率提高
PGD顯示胚胎染色體正常, 不論其母體卵巢功能是否下降, 移植後著床率無明顯差異

Fertil Steril. 2016 Jun 28. pii: S0015-0282(16)61345-6. doi: 10.1016/j.fertnstert.2016.06.016. [Epub ahead of print]

Higher rates of aneuploidy in blastocysts and higher risk of no embryo transfer in recurrent pregnancy loss patients with diminished ovarian reserve undergoing in vitro fertilization.

Shahine LK1, Marshall L2, Lamb JD2, Hickok LR2.

Author information

Abstract

OBJECTIVE:

To study the prediction of aneuploidy rate in blastocysts from patients with recurrent pregnancy loss (RPL) on the basis of ovarian reserve testing.

DESIGN:

Prospective cohort analysis.

SETTING:

Private, university-affiliated fertility clinic.

PATIENT(S):

A total of 239 patients with RPL, defined as two or more clinical miscarriages, were screened for inclusion. One hundred two (102) cycles in patients with unexplained RPL resulted in at least one euploid embryo transferred. Outcomes were compared by ovarian reserve test results, with diminished ovarian reserve (DOR) defined as a cycle day 3 FSH >10 IU/mL and/or antimüllerian hormone <1 ng/mL.

INTERVENTION(S):

In vitro fertilization with blastocyst biopsy and aneuploidy screening of all 23 chromosome pairs.

MAIN OUTCOME MEASURE(S):

Rate of aneuploidy in blastocysts and incidence of IVF cycles with no transfer owing to no euploid blasts.

RESULT(S):

Patients with DOR had a higher percentage of aneuploid blastocysts (57% vs 49%) and a higher incidence of no euploid embryos to transfer (25% vs 13%). The higher rate of aneuploidy in blastocysts was most significant in patients aged <38 years (67% vs 53%). Implantation rates after transfer of euploid blastocysts were similar (61% compared with 59%), and miscarriage rates were low (14% and 10%).

CONCLUSION(S):

Unexplained RPL patients with DOR have a higher percentage of aneuploid blastocysts and risk of no euploid embryo to transfer compared with unexplained RPL patients with normal ovarian reserve testing. The difference is most significant in patients aged <38 years. Patients with RPL and DOR with euploid embryo transferred had similar outcomes compared with patients with RPL and normal ovarian reserve testing.