Zhongguo quanke yixue (Jan 2023)
Factors Associated with the Outcomes of Preimplantation Genetic Testing in Assisted Reproduction
Abstract
Background Embryo anomaly is the most common cause of implantation failure and abortion in women of reproductive age. However, there is controversy about the cause of implantation failure or miscarriage that occurs after the transfer of a normal embryo screened by preimplantation genetic testing (PGT) . Objective To analyze the influencing factors affecting implantation failure and miscarriage after PGT assisted reproduction. Methods Three hundred and twenty-nine women who received PGT assisted reproduction in Reproductive Center, the First Affiliated Hospital of Anhui Medical University from December 2018 to February 2021 were enrolled, including 218 with clinical pregnancy〔175 of whom had a live birth (live birth subgroup) , and 43 had an abortion (abortion subgroup) 〕, and 111 with implantation failure. Clinical data, results of accessory examinations, ovulation induction and in vitro embryonic development were compared between women with clinical pregnancy and implantation failure, and between live birth and abortion subgroups. The influencing factors of implantation failure and abortion after PGT assisted reproduction were screened by multivariate logistic regression analysis, and predictive values of the determined factors for implantation failure and abortion were estimated using the receiver operating characteristic (ROC) analysis. Results Multivariate logistic regression analysis showed that, two or more previous abortions〔OR=4.032 0, 95%CI (2.423 0, 6.710 0) 〕 and low level of high-density lipoprotein cholesterol (HDL-C) 〔OR=3.890 0, 95%CI (1.455 0, 10.403 0) 〕were risk factors for implantation failure after PGT assisted reproduction (P<0.05) , while the low gonadotropin (Gn) dosage〔OR=0.999 5, 95%CI (0.999 2, 0.999 9) 〕 was associated with decreased risk of implantation failure after PGT assisted reproduction (P<0.05) . Two or more abortions〔OR=2.203 0, 95%CI (1.099 0, 4.417 0) 〕 and low normal rate of embryo biopsy〔OR=5.655 0, 95%CI (1.286 0, 24.865 0) 〕 were associated with increased risk of abortion after PGT assisted reproduction (P<0.05) , while low fasting insulin (FINS) level〔OR=0.912 0, 95%CI (0.835 0, 0.996 0) 〕 was associated with decreased risk of abortion after PGT assisted reproduction (P<0.05) . ROC analysis indicated that for predicting implantation failure after PGT assisted reproduction, the AUC of two or more previous abortions was 0.650 with 70.3% sensitivity, 59.6% specificity and Youden index of 0.299, the AUC of HDL-C level was 0.579 with 33.3% sensitivity, 80.3% specificity and Youden index of 0.136, and the AUC of the dosage of Gn was 0.561 with 60.4% sensitivity, 56.9% specificity and Youden index of 0.173. The AUC of two or more previous abortions for predicting the abortion after PGT assisted reproduction was 0.648 with 66.2% sensitivity, 63.4% specificity and Youden index of 0.296, and the AUC of fasting insulin level was 0.629 with 72.1% sensitivity, 52.6% specificity and Youden index of 0.247, and that of normal embryo biopsy rate was 0.641 with 65.1% sensitivity, 60.6% specificity and Youden index of 0.257. Conclusion Two or more previous abortions, dosage of Gn and serum HDL-C were influencing factors and partial predictors of implantation failure after PGT assisted reproduction. And two or more previous abortions, fasting insulin level, and normal embryo biopsy rate were influencing factors and partial predictors of abortion after PGT assisted reproduction.
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