【摘要】 目的 分析在单基因疾病和染色体结构重排的植入前遗传学检测助孕周期中，累积活产率与获卵数、活检囊胚数和可移植囊胚数的相关性。方法 回顾性分析2016年1月至2020年12月因单基因疾病或染色体结构重排在湖北医药学院附属人民医院生殖医学中心接受胚胎植入前遗传学检测(PGT)助孕患者的一般情况、实验室指标及临床结局，通过曲线拟合及阈值效应分析获卵数、可活检囊胚数和可移植囊胚数对累积活产率的影响。结果 本研究共纳入307(268对夫妇)个周期，其中54个周期(17.59%)为单基因病检测(PGT-M)周期，253个周期(82.41%)为染色体重排检测(PGT-SR)周期。39对夫妇由于初个取卵周期无可用胚胎或者未获得活产而接受了第2或第3个取卵周期。女方平均年龄为(30.14±4.16)岁。校正女方年龄、体质量指数(BMI)、抗苗勒管激素(AMH)及基础窦卵泡数(AFC)后对患者获卵数、可活检囊胚数分别与至少有1个可移植囊胚概率进行曲线拟合分析，结果显示：获卵数与至少有1个可移植囊胚的概率显著相关[RR=1.108,95%CI(0.976,1.227),P=0.000],随着获卵数的增多，可移植囊胚率逐渐增加；同样，每周期可活检囊胚数与至少有1个可移植囊胚的概率显著相关[RR=1.155,95%CI(0.994,1.242),P=0.000],随着可活检囊胚数的增加，有可移植囊胚率逐渐增加。获卵数[OR=1.041,95%CI(0.883,1.211),P=0.014]和可移植囊胚数[OR=1.276,95%CI(1.111,1.409),P=0.042]对累积活产率有显著影响，在获卵数<10个时，随着获卵数的增加，累积活产率逐渐增加，最高可达83.33%;当获卵数≥10个时，累积活产率趋于平稳。结论 PGT-M/PGT-SR助孕周期中，累积活产率随着获卵数、可活检囊胚数和可移植囊胚数的增加而逐渐上升；当每周期获卵数≥10个时，患者的累积活产率趋于平稳，不再增加。更多还原

【Abstract】 Objective:To investigate the correlation between the cumulative live birth rate and the numbers of oocyte retrieved, blastocysts biopsied and transplantable blastocysts in the reproductive assistant cycles of preimplantation genetic testing(PGT)for monogenic disorders and chromosomal structural rearrangements.Methods:The general condition, laboratory indicators and clinical outcomes of the patients who received PGT due to monogenic disorders or chromosome structure rearrangement in the reproductive medicine center of the People’s Hospital Affiliated to Hubei University of Medicine from January 2016 to December 2020 were retrospectively analyzed. The curve fitting and threshold effect analysis were performed to analyze the influence of the number of oocytes retrieved, blastocysts biopsied and transplantable blastocysts on the cumulative live birth rate.Results:A total of 307 cycles(268 couples) were included in this study, of which 54 cycles(17.59%) were monogenic disorders detection(PGT-M) cycles and 253 cycles(82.41%) were chromosome structural rearrangement detection(PGT-SR) cycles. Thirty-nine couples received the second or third oocytes retrieval cycle because there were no embryos available or live births in the first cycle. The mean female age was(30.14±4.16) years. After adjusting for the woman’s age, BMI,AMH and AFC,a curve fitting analysis was performed between the number of oocytes retrieved & the number of blastocysts biopsied and probability of having at least one transplantable blastocyst. The results showed that the number of oocytes retrieved was significantly correlated with the probability of having at least one blastocyst transplantable[RR=1.108,95%CI(0.976,1.227),P=0.000]. With the increase of the number of oocytes retrieved, the transplantable blastocyst rate gradually increased. Similarly, the number of blastocysts biopsied per cycle was significantly correlated with the probability of having at least one transplantable blastocyst [RR=1.155,95%CI(0.994,1.242),P=0.000]. With the increase of the number of blastocysts biopsied, the transplantable blastocyst rate gradually increased. The number of oocytes retrieved [RR=1.041,95%CI(0.883,1.211),P=0.014] and the number of transplantable blastocysts [RR=1.276,95%CI(1.111,1.409),P=0.042] had a significant effect on the cumulative live birth rate. When the number of oocytes retrieved was less than 10,with the increase of the number of oocytes retrieved, the cumulative live birth rate gradually increased, up to 83.33%. When the number of oocytes retrieved ≥10,the cumulative live birth rate tended to be stable.Conclusions:In PGT-M and PGT-SR reproductive assistant cycles, the cumulative live birth rate increases gradually with the increase of the numbers of oocytes retrieved, blastocysts biopsied and transplantable blastocysts. When the number of oocytes retrieved per cycle is ≥10,the cumulative live birth rate of patients tends to be stable and does not increase.更多还原