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镶嵌胚胎和非镶嵌胚胎的存活率没有差异

游海 2021-12-28 11:59 试管之家 查看: 59 评论: 0

摘要:   一项新的非选择性临床试验表明,许多因染色体异常而被丢弃的体外受精胚胎可能会导致成功怀孕和健康婴儿。  目前,只有不到3%的镶嵌胚胎(混合了正常细胞和非整倍体细胞)在试管婴儿期间被转移到子宫中,因为他 ...
  一项新的非选择性临床试验表明,许多因染色体异常而被丢弃的体外受精胚胎可能会导致成功怀孕和健康婴儿。

  目前,只有不到3%的镶嵌胚胎(混合了正常细胞和非整倍体细胞)在试管婴儿期间被转移到子宫中,因为他们认为它们不可行。这种做法限制了IVF,因为患者可以使用的替代胚胎很少,尽管有有限的证据表明镶嵌胚胎是不可行的,因为少数异常细胞可能不会影响胎儿发育。

  '众所周知,假定的镶嵌胚胎可以发育成足月并生出健康的婴儿,但之前许多研究这个问题的研究都受到了对预后不良患者人群的选择偏倚的影响,因为他们以前曾植入失败该研究的第一作者、意大利马罗斯蒂卡Igenomix实验室主任安东尼奥·卡帕尔博博士说,该实验室专门从事基因组检测服务。

  在发表在《美国人类遗传学杂志》上的临床试验中,胚胎进行了植入前基因检测,专门寻找镶嵌非整倍体。除了整倍体胚胎(没有非整倍体的胚胎)之外,具有低级嵌合(20%到30%的非整倍体细胞)和中等嵌合(30%到50%的非整倍体细胞)的胚胎被盲目地报告为整倍体并被植入。这种策略避免了偏见,因为任何符合定义标准的胚胎都可以用于植入。

  研究人员发现,在484个整倍体、282个低级嵌合体和131个中级嵌合体胚胎中,嵌合体胚胎植入子宫的可能性与正常胚胎一样,并且成为健康婴儿的可能性相同。学期。三组的产科和新生儿结局也相似。

  三组之间的流产率相似,并且在所调查的导致流产的妊娠中,没有一个是由于非整倍体引起的。

  '这是一个在过去十年中引起了很多争议的领域,有些人盲目相信,有些人认为这是错误的。它已经分裂了这个领域,没有参与这项研究的国王生育中心主任Ippokratis Sarris博士在《电讯报》上评论道。'临床医生和医生都在问:“我应该如何处理马赛克胚胎?”我们越来越有信心放回马赛克胚胎并看看会发生什么。

  研究人员希望这项研究能够改变目前关于在IVF治疗之前使用和报告镶嵌胚胎的指南,从而使患者能够对镶嵌胚胎的移植做出更明智的决定,根据试验,镶嵌胚胎可以被认为是健康和正常的。

  以下原文:

  No difference in viability found between mosaic and non-mosaic embryos

  Many IVF embryos discarded due to chromosomal abnormalities could lead to viable pregnancies and healthy babies,a new non-selection clinical trial has suggested.

  Currently fewer than three percent of mosaic embryos,which have a mixture of normal and aneuploid cells,are transferred into the uterus during IVF due to a belief they are not viable.This practice limits IVF where few alternative embryos are available to a patient,although there is limited evidence to suggest that mosaic embryos are not viable as a few abnormal cells might not affect fetal development.

  'It was already known that putative mosaic embryos can develop to term and make healthy babies,but many of the previous studies that looked at this issue were affected by selection bias toward a population of patients that had a poor prognosis because they had previously failed implantations with euploid embryos,'said first author of the study Dr Antonio Capalbo,laboratory director at Igenomix,Marostica,Italy,which specialises in genomic testing services.

  In the clinical trial,published in the journal American Journal of Human Genetics,embryos were tested with pre-implantation genetic testing that looked specifically for mosaic aneuploidy.In addition to euploid embryos(those with no aneuploidy),embryos with low-grade mosaicism(20 to 30 percent aneuploid cells)and medium-grade mosaicism(30 to 50 percent aneuploid cells)were blindly reported as euploid and implanted.This strategy avoided bias as any embryo that fitted the defined criteria could be used for implantation.

  The investigators found that across 484 euploid,282 low-grade mosaic,and 131 medium-grade mosaic embryos,the mosaic embryos were as likely to implant in the uterus as the normal embryos,and had the same likelihood of becoming a healthy baby carried to term.The obstetric and neonatal outcomes were also similar across the three groups.

  Miscarriage rates were similar across the three groups and of the pregnancies which resulted in miscarriage which were investigated,none were due to aneuploidy.

  'This is an area that has created a lot of controversy over the last decade,with some who believe it blindly and some who believe it's wrong.It has divided the field'Dr Ippokratis Sarris,director of King's Fertility,who was not involved in the study,commented in the Telegraph.'Clinicians and doctors are asking:"what should I do with mosaic embryos?"We're becoming more confident in putting back mosaic embryos and seeing what happens.'

  The researchers expect the study to change current guidelines on the use and reporting of mosaic embryos prior to IVF treatment,thus allowing patients to make more informed decisions about the transfer of mosaic embryos,which can be deemed healthy and normal according to the trial.

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