IVF embryo choices and pregnancy outcomes

作者：Wang, Li; Wang, Xiaohong; Liu, Yun; Ou, Xianghong; Li, Min; Chen, Lei; Shao, Xiaoguang; Quan, Song; Duan, Jinliang; He, Wei; Shen, Huan; Sun, Ling; Yu, Yuexin; Cram, David S.; Leigh, Donald; Yao, Yuanqing^*

来源：Prenatal Diagnosis, 2021, 41(13): 1709-1717.

DOI：10.1002/pd.6042

• BLASTOCYST
• IMPLANTATION
• MORPHOLOGY
• EUPLOIDY
• CYCLES

Objective Investigate the chromosome status and transfer outcomes of embryos selected using routine "best morphology" IVF practices. Method A prospective multi-center, non-selection cohort study involving patients undertaking IVF treatment. Study entry conditions were blastocyst biopsy, >1 embryo with chromosome analysis and frozen transfer of the best morphology embryo. Primary analyses were beta hCG positive, implantation, ongoing pregnancy and birth rates and pregnancy-stage progression failures. Results After transfer, embryo chromosome status was assigned and outcomes divided into two primary groups - euploids (n = 135) and aneuploids (n = 53). Compared to euploid embryo transfers, aneuploid embryos had significantly lower primary outcomes (+beta hCG: 67% vs. 30%, p < 0.0001; IR: 56% vs. 19%, p < 0.0001; ongoing week 12: 51% vs. 9%, p < 0.0001; and livebirths: 50% vs. 8%, p < 0.0001, respectively). Transfers were further subdivided into smaller groups according to their main chromosomal feature. Stage analysis showed higher failure rates for aneuploids to initiate a pregnancy (p < 0.0001), higher subclinical miscarriage rate (p = 0.0402) and higher clinical miscarriage rate (p = 0.0038). Conclusion Routine morphology-based embryo selection resulted in a high euploid selection rate but a significant number of aneuploid embryos were still inadvertently selected for transfer (28%) with the subsequent high failure rates for pregnancy initiation and progression having implications for appropriate patient management.

• 单位
  南方医科大学; 中国人民解放军第四军医大学; 广州医学院; 北京大学