Influence Of The Application Of PGT With Pregnancy Outcome And The Health Of Maternal And Infant In ART

BackgroundNowadays,the rate of infertility has been on the rise,and it has become a serious public health problem.The World Health Organization predicts that infertility will become the third biggest disease after cancer and cardiovascular disease in the 21st century.Infertility not only causes great psychological pressure and economic burden to pregnant couples,but also becomes a disadvantageous factor for family harmony and social stability.The emergence of assisted reproductive technology become the key to solve the problem of infertility and reproductive,but subsequent related security problem also has attracted widespread attention,assisted reproductive technology involves the main security issues including line assisted reproductive patients after pregnancy outcomes,pregnancy complications,neonatal condition and their growth and development,etc.With the development of in vitro fertilization(IVF),the application of preimplantation genetic testing(PGT)has steadily increased over the past decades.PGT is a combination of IVF and genetic diagnosis,whose aim is to provide an alternative reproductive option for couples at risks of giving birth to offspring with severe genetic diseases of childhood-onset,so as to avoid the physical and psychological trauma related to abortions when an affected pregnancy is diagnosed after spontaneous pregnancy.Thus,as the earliest form of prenatal diagnosis,it is utilized to select embryos that are unaffected by a genetic disease,has a normal karyotype,shows a human leukocyte antigen(HLA)match with a sibling,has a lessened cancer predisposition,or are the desired sex.ObjectivesPGT is a salutary technology to help prospective parents who are carriers of a serious genetic condition reduce the risk of having affected offspring.Despite the advantage of PGT,information on pregnancy outcome after the procedure is scarce,therefore,we analyzed the data on the medical outcome with or without PGT.The groups of patients with IVF-ET and ICSI similar to the treatment with PGT,and during the same study period was included to determine whether potential discrepancies in pregnancy outcome could be exclusively attributed to the PGT or not.This study is useful for seeing the given condition and the risks,benefits,and limitations of PGT,and prophylaxis of adverse pregnancy outcomes.It has many significances such as clinical guidance,prenatal and postnatal care,maternal and child health.Materials and methodsThis historical cohort study included 16948 cycles which were performed at Reproductive Hospital Affiliated to Shandong University for investigation of the cause of infertility and treatment between January 2016 and December 2017.In the light of protocols,the cases were divided into three groups:12953 cycles,3336 cycles,and 659 cycles for IVF-ET,ICSI,and PGT groups,respectively.Patients underwent ovarian stimulation,oocyte retrieval and embryo transfer per the standard protocol which was selected according to the indications of infertility and the preference of attending doctor.Trophectoderm biopsy was used for PGT and performed by experienced embryologists and technicians in our center.Besides,all included cases involved FET and single-embryo transfer procedures.There were no exclusions of male-factor(i.e.oligospermia,asthenospermia,azoospermatism,ejaculation disorder,and retrograde ejaculation),and the use of donor semen was allowed.All analysis was performed using STATA version 15.1(STATA Corp.,College Station,TX,USA).Categorical variables were shown as frequencies and percentages.A chi-square test was used for inter-group comparison of differences in these variables,and relative risks(RR)and 95%confidence intervals(CI)were presented.Continuous variables were expressed as mean ±standard deviation(x±s),with the between-group difference tested by means of Student’s t-test.One-way analysis of variance(ANOVA),Fisher’s exact and chi-square tests were used to compare the three groups.A P value of<0.05 was considered statistically significant.ResultsIn this study,a total of 16948 cycles with embryo transfer procedures and pregnancy outcomes were enrolled(IVF-ET group:12953,ICSI group:3336,PGT group:659,respectively).Of these,there were 9070 clinical pregnancies and 7076 newborns recorded(IVF-ET group:7083 and 5622,ICSI group:1626 and 1217,PGT group:361 and 237).The average maternal age was 32.3±4.9 years,being lowest in the ICSI group(30.9 ±4.9 years)and highest in the PGT group(34.2±4.9 years),and the advanced maternal aged of PGT was more frequent(42.8%)compared with either IVF-ET(32.4%)or ICSI(22.5%)(P=0.000).The patient history and concomitant infertility factors were statistically significantly different among the three groups(P=0.000).In the PGT group,a significant increase in the clinical pregnancy rate was observed compared with the ICSI groups(54.8%vs.48.7%,rate ratio 1.13;95%confidence interval,1.04～1.22;P=0.004).And the clinical miscarriage rate was higher in the PGT groups(17.8%)than both the IVF-ET and the ICSI groups(10.5%,RR=1.69;95%CI,1.43～2.01;P=0.000;11.2%,RR=1.58;95%CI,1.31～1.92;P=0.000,respectively).There was a statistically significant difference in the live birth rate between the PGT group and the IVF-ET group(36.7%vs.43.6%,RR=0.84;95%CI,0.76～0.93;P=0.000),on account of the difference in partus maturus(34.5%vs.40.1%,RR=0.86;95%CI,0.77～0.96;P=0.000).The incidence of hypertension differed significantly between the PGT group and the IVF group(2.1%vs.5.6%,RR=0.37;95%CI,0.15～0.89;P=0.019),meanwhile,the incidence of diabetes was significantly higher in the PGT group than in the ICSI group(9.54%vs.5.6%,RR=1.58;95%CI,1.01～2.47;P=0.045).The cesarean delivery rates were similar in all groups(72.1%,69.0%,68.91%,respectively,P=0.062).Stratified analysis showed that for advanced maternal age,the clinical pregnancy rate of PGT was higher than IVF-ET(P=0.001)and ICSI(P=0.000),and the live birth rate was also higher than that of ICSI(P=0.000).For patients with recurrent pregnancy loss,the clinical pregnancy rate and miscarriage rate in the PGT group were not significantly different from the other two groups,but the live birth rate was higher than IVF-ET(P=0.024).In neonates,there was no statistically significant difference among the groups in term of birth weight(3.44±0.54kg,3.43 ± 0.50kg,3.42 ± 0.49kg,respectively,P=0.651)and low birth weight(3.85%,3.05%,2.54%,respectively,P=0.264).The sex ratio was significantly shifted toward females in PGT and ICSI groups while toward males in the IVF-ET group in spite of similar birth weight between groups.Conclusions1.In terms of pregnancy outcome,the clinical pregnancy rate in the PGT group was higher than that in the ICSI group,as the higher abortion rate,the live birth rate was similar to the ICSI group and lower than IVF-ET group,yet it may be caused by the characteristics and underlying infertility of patients.2.In terms of pregnancy complications,the PGT may increased the risk of gestational diabetes and reduced the risk of hypertension during pregnancy.3.The birth weight and sex ratio of the.neonates in the PGT group were not different from the IVF-ET and ICSI groups,more studies about them are needed.4.Compared with IVF-ET and ICSI,PGT is more suitable for the patients who are advanced age and RPL.