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PGT-A在临床试验中并未提高活产率

游海 2021-12-28 11:34 试管之家 查看: 49 评论: 0

摘要:   最近的一项研究发现,非整倍体(PGT-A)的植入前基因检测可能不会提高活产率。  PGT-A是许多生育诊所提供的附加产品,因为人们相信不移植非整倍体胚胎将有助于降低流产率和提高活产率。之前的研究表明,它可以帮 ...
  最近的一项研究发现,非整倍体(PGT-A)的植入前基因检测可能不会提高活产率。

  PGT-A是许多生育诊所提供的附加产品,因为人们相信不移植非整倍体胚胎将有助于降低流产率和提高活产率。之前的研究表明,它可以帮助提高老年妇女的活产率,但几乎没有研究它如何影响年轻健康妇女的结果。PGT-A也可能是不受欢迎的,因为它涉及丢弃非整倍体胚胎,与传统的IVF治疗相比,这可能会使预期的父母转移更少。

  加州洛杉矶南加州大学生育中心主任理查德保尔森教授没有参与这项研究,他说:“如果你是一个预后良好的人......并且你有三个囊胚,那么不参与对你最有利做基因检测。

  这项研究在《新英格兰医学杂志》上有详细介绍,在中国的14个生育中心进行。这项随机对照试验涉及1212名年龄在20-37岁之间的不育女性,由于没有反复流产史或未植入胚胎的IVF周期,她们很有可能活产。

  该试验平均分为两组,研究了一年内的活产率,并针对有ICSI和PGT-A的IVF和没有PGT-A的女性进行了多达3次胚胎移植。他们发现两组之间的比率相似,胚胎接受PGT-A筛查的女性活产率为85.3%,未接受胚胎筛查的女性活产率为82.5%。

  在接受PGT-A的组中发现流产率较低(8.7%对12.6%),但传统IVF组中更多的女性在一年内进行了第二次或第三次胚胎移植,这表明有更多的胚胎可用对于这个组。

  该研究的作者得出结论,虽然PGT-A不支持预后良好的女性,但他们的结果不一定适用于老年女性或经历过多次流产或植入失败的女性。他们还指出,他们对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。

  在评论,伴随着一片Sebastiaan MASTENBROEK博士从大学医疗中心在荷兰阿姆斯特丹和其他人谁没有参与指出,研究胚胎学家:根据美国疾病控制和预防的2018年生育诊所成功率报告”,在美国,有37.7%的IVF周期使用了PGT,导致胚胎移植。他继续指出,虽然FDA现在没有对美国的一些生育诊所“附加”进行监管,但公众呼吁加强监管。他警告该行业必须谨慎创新“责任”,以避免未来潜在的集体诉讼。

  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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