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PGT-A在臨床試驗中并未提高活產率

游海 2021-12-28 11:34 試管之家 查看: 33 評論: 0

摘要:   最近的一項研究發現,非整倍體(PGT-A)的植入前基因檢測可能不會提高活產率?! GT-A是許多生育診所提供的附加產品,因為人們相信不移植非整倍體胚胎將有助于降低流產率和提高活產率。之前的研究表明,它可以幫 ...
  最近的一項研究發現,非整倍體(PGT-A)的植入前基因檢測可能不會提高活產率。

  PGT-A是許多生育診所提供的附加產品,因為人們相信不移植非整倍體胚胎將有助于降低流產率和提高活產率。之前的研究表明,它可以幫助提高老年婦女的活產率,但幾乎沒有研究它如何影響年輕健康婦女的結果。PGT-A也可能是不受歡迎的,因為它涉及丟棄非整倍體胚胎,與傳統的IVF治療相比,這可能會使預期的父母轉移更少。

  加州洛杉磯南加州大學生育中心主任理查德保爾森教授沒有參與這項研究,他說:“如果你是一個預后良好的人......并且你有三個囊胚,那么不參與對你最有利做基因檢測。

  這項研究在《新英格蘭醫學雜志》上有詳細介紹,在中國的14個生育中心進行。這項隨機對照試驗涉及1212名年齡在20-37歲之間的不育女性,由于沒有反復流產史或未植入胚胎的IVF周期,她們很有可能活產。

  該試驗平均分為兩組,研究了一年內的活產率,并針對有ICSI和PGT-A的IVF和沒有PGT-A的女性進行了多達3次胚胎移植。他們發現兩組之間的比率相似,胚胎接受PGT-A篩查的女性活產率為85.3%,未接受胚胎篩查的女性活產率為82.5%。

  在接受PGT-A的組中發現流產率較低(8.7%對12.6%),但傳統IVF組中更多的女性在一年內進行了第二次或第三次胚胎移植,這表明有更多的胚胎可用對于這個組。

  該研究的作者得出結論,雖然PGT-A不支持預后良好的女性,但他們的結果不一定適用于老年女性或經歷過多次流產或植入失敗的女性。他們還指出,他們對研究中的所有女性都使用了ICSI,但并非所有IVF患者都使用了ICSI。

  在評論,伴隨著一片Sebastiaan MASTENBROEK博士從大學醫療中心在荷蘭阿姆斯特丹和其他人誰沒有參與指出,研究胚胎學家:根據美國疾病控制和預防的2018年生育診所成功率報告”,在美國,有37.7%的IVF周期使用了PGT,導致胚胎移植。他繼續指出,雖然FDA現在沒有對美國的一些生育診所“附加”進行監管,但公眾呼吁加強監管。他警告該行業必須謹慎創新“責任”,以避免未來潛在的集體訴訟。

  以下原文:

  PGT-A did not improve live birth rate in clinic trial

  A recent study found that preimplantation genetic testing for aneuploidy(PGT-A)may not improve live birth rate.

  PGT-A is an add-on that many fertility clinics offer,due to the belief that not transferring aneuploid embryos will help to reduce miscarriage rate and improve live birth rate.Previous research had suggested that it could help improve live birth rate for older women but there was little research into how it impacted outcomes for young,healthy women.PGT-A is also potentially undesirable as it involves discarding aneuploid embryos,which can leave intended parents with fewer to have transferred than conventional IVF treatment.

  Professor Richard Paulson director of USC Fertility in Los Angeles,California who was not involved in the research said:'If you are someone who is in a good prognosis group...and you have three blastocysts,it is in your best interest to not do the genetic testing.'

  The research,detailed in the journal New England Journal of Medicine,was carried out across 14 fertility centres in China.The randomised,controlled trial involved 1212 subfertile women,ages 20-37,who had a good likelihood of having a live birth due to no history of recurring miscarriages or IVF cycles where the embryo had not implanted.

  Split equally into two groups the trial looked at the live birth rate within a year and with up to three embryo transfers for women who had IVF with ICSI with PGT-A,and without PGT-A.They found similar rates between the two groups with a live birth rate of 85.3 percent for women whose embryos received PGT-A screening and 82.5 percent for women whose embryos did not.

  A lower rate of miscarriage was found in the group who received PGT-A(8.7 percent compared to 12.6 percent),but more women in the conventional IVF group had second or third transfers of their embryos within a year,suggesting there were more embryos available for this group.

  The authors of the study conclude that while PGT-A is not supported for women with a good prognosis,their results are not necessarily applicable to older women or women who have experienced multiple pregnancy loss or implantation failure.They also note they used ICSI for all women in the study which is not used for all IVF patients.

  In a commentary that accompanied the piece Dr Sebastiaan Mastenbroek an embryologist from University Medical Centres in Amsterdam,the Netherlands and others who were not involved in the research noted:'According to the 2018 Fertility Clinic Success Rates Report of the Centres for Disease Control and Prevention,PGT was used in 37.7 percent of all IVF cycles that resulted in an embryo transfer,'in the USA.He went on to point out that although the FDA does not regulate some fertility clinic'add-ons'in the USA now,the public is calling for increased regulation.He warned the sector must be careful to innovate'responsibility'to avoid potential class-action lawsuits in future.

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