PGT可能會下降累積活產率 尤其是<35歲患者

>40歲以上無明顯降低

J Assist Reprod Genet 2023 Jan;40(1):137-149.

 doi: 10.1007/s10815-022-02667-x. Epub 2022 Dec 1.

PGT-A is associated with reduced cumulative live birth rate in first reported IVF stimulation cycles age ≤ 40: an analysis of 133,494 autologous cycles reported to SART CORS

Purpose: To evaluate the impact of preimplantation genetic testing for aneuploidy (PGT-A) on cumulative live birth rate (CLBR) in IVF cycles.

Methods: Retrospective cohort study of the SART CORS database, comparing CLBR for patients using autologous oocytes, with or without PGT-A. The first reported autologous ovarian stimulation cycle per patient between January 1, 2014, and December 31, 2015, and all linked embryo transfer cycles between January 1, 2014, and December 31, 2016, were included in the study. Exclusion criteria were donor oocyte cycles, donor embryo cycles, gestational carrier cycles, cycles which included both a fresh embryo transfer (ET) combined with a thawed embryo previously frozen (ET plus FET), or cycles with a fresh ET after PGT-A.

Results: A total of 133,494 autologous IVF cycles were analyzed. Amongst patients who had blastocysts available for either ET or PGT-A, including those without transferrable embryos, decreased CLBR was noted in the PGT-A group at all ages, except ages > 40 (p < 0.01). A subgroup analysis of only those patients who had PGT-A and a subsequent FET, excluding those without transferrable embryos, demonstrated a very high CLBR, ranging from 71.2% at age < 35 to 50.2% at age > 42. Rates of multiple gestations, preterm birth, early pregnancy loss, and low birth weight were all greater in the non-PGT-A group.

Conclusions: PGT-A was associated with decreased CLBR amongst all patients who had blastocysts available for ET or PGT-A, except those aged > 40. The negative association of PGT-A use and CLBR per cycle start was especially pronounced at age < 35.

用 精子分離装置 (Zymot)。比傳統精蟲分離方式(DCC)可達到較高比率正常染色體囊胚

https://www.mdpi.com/2075-1729/15/2/302

採用 精子分離装置 (SSD)。比傳統精蟲分離方式可篩選出具有高活力且 DNA 損傷較少的精子群體，

. 2024 Aug;41(8):2201-2209.

 doi: 10.1007/s10815-024-03168-9. Epub 2024 Jun 18.

Optimized sperm selection: a highly efficient device for the isolation of progressive motile sperm with low DNA fragmentation index

Purpose: To identify the sperm preparation procedure that selects the best sperm population for medically assisted reproduction.Methods: Prospective observational study comparing the effect of four different sperm selection procedures on various semen parameters. Unused raw semen after routine diagnostic analysis was split in four fractions and processed by four different methods: (1) density gradient centrifugation (DGC), (2) sperm wash (SW), (3) DGC followed by magnetic activated cell sorting (MACS), and (4) using a sperm separation device (SSD). Each fraction was analyzed for progressive motility, morphology, acrosome index (AI), and DNA fragmentation index (DFI).Results: With DGC as standard of care in intraclass correlation coefficient analysis, only SSD was in strong disagreement regarding progressive motility and DFI [0.26, 95%CI (- 0.2, 0.58), and 0.17, 95%CI (- 0.19, 0.45), respectively]. When controlling for abstinence duration, DFI was significantly lower after both MACS and SSD compared to DGC [- 0.27%, 95%CI (- 0.47, - 0.06), p = 0.01, and - 0.6%, 95%CI (- 0.80, - 0.41), p < 0.001, respectively]. Further comparisons between SSD and MACS indicate significantly less apoptotic cells [Median (IQR) 4 (5), 95%CI (4.1, - 6.8) vs Median (IQR) 5 (8), 95%CI (4.9, - 9.2), p < 0.001, respectively] and dead cells [Median (IQR) 9.5 (23.3), 95%CI (13.2, - 22.4) vs Median (IQR) 22 (28), 95%CI (23.1, - 36.8), p < 0.001, respectively] in the SSD group.Conclusion: The selection of a population of highly motile spermatozoa with less damaged DNA from unprocessed semen is ideally performed with SSD. Question remains whether this method improves the embryological outcomes in the IVF laboratory.

Table 2.

Descriptive analysis of the effect of four different preparation techniques on concentration, progressive motility, normal morphology, AI, and DFI

	SW	DGC	MACS	SSD
Concentration (× 106)	61.7 ± 35.4 (17.5–193.0)	13.0 ± 11.6 (0.8–68)	8.4 ± 9.2 (0.61–49.6)	15.1 ± 14.2 (1.5–69.0)
Progressive motility (%)	54.3 ± 10.6 (23–86)	74.3 ± 11.8 (38–90)	77.2 ± 12.5 (37–92)	88.6 ± 4.2 (73–96)
Normal morphology (%)	3.3 ± 2.9 (0–13)	4.1 ± 3.1 (0–13)	4.2 ± 3.7 (0–18)	5.1 ± 3.9 (0–16)
AI (%)	8.5 ± 4.9 (1–20)	9.7 ± 6 (1–30)	8.7 ± 4.9 (0–19)	10.8 ± 6.8 (1–30)
DFI (%)	6.2 ± 4.6 (0.8–26.1)	2.7 ± 3.2 (0.2–14)	2.1 ± 4.3 (0.9–20.8)	0.2 ± 0.4 (0–2.3)

Fig. 2 

Capacity of MACS and SSD procedures to remove apoptotic (A) and dead (B) cells from sperm cell population (Wilcoxon signed-rank test). Spearman correlation test between the days of abstinence and the presence of dead cells in selected sperm population after MACS (C). Abbreviations: MACS: magnetic activated cell sorting, SSD: microfluidic sperm sorting