Objective: To investigate the impact of the number of previous miscarriages on embryo euploid rate and pregnancy outcomes after preimplantation genetic testing for aneuploidies (PGT-A) in patients with unexplained recurrent pregnancy loss (uRPL). Methods: A retrospective cohort study was conducted. 799 women with uRPL who underwent PGT-A for the first time between January 2015 and December 2021 at the Reproductive center of Shandong University were enrolled. These patients were divided into three groups according to the number of previous miscarriages (2, 3, and≥4). Stratified analysis was conducted according to female age (≤37 years and>37 years). The embryo euploidy rate, good-quality blastocyst formation rate, cumulative live birth rate, and cumulative clinical pregnancy loss rate of three groups were compared in younger and older patients, respectively. Meanwhile, the cumulative live birth rate, clinical pregnancy loss rate, and embryo euploidy rate were analyzed by multivariate logistic regression analysis. Results: Patients' age was (34.7±5.1) years old. In the three groups with 2, 3 and ≥4 previous miscarriages, there was no significant difference in the embryo euploidy rate between groups in the younger [48.9% (539/1 103), 50.6% (354/700) and 52.1% (152/292), P=0.567] and older [26.2% (103/393), 28.8% (55/191) and 20.5% (16/78), P=0.377] age population. Compared with 2 and 3 previous miscarriages, the cumulative live birth rate was significantly decreased [52.6% (153/291), 52.8% (93/176) and 34.3% (25/73), P=0.014] and the cumulative clinical pregnancy loss rate was significantly increased [15.8% (31/196), 15.3% (18/118) and 46.9% (23/49), P<0.001] in younger women with ≥4 miscarriages. After adjusting for maternal age, BMI, AMH, endometrial thickness on hCG trigger day and antral follicle count, the number of previous miscarriages ≥4 was a relevant factor for cumulative live birth rate (OR=0.461, 95%CI: 0.263-0.807, P=0.007) and the cumulative clinical pregnancy loss rate (OR=4.382, 95%CI: 2.165-8.873, P<0.001) in younger patients, but it was not significantly correlated with the cumulative live birth rate, cumulative clinical pregnancy loss rate and embryo euploidy rate in patients with advanced age. Conclusion: In uRPL patients,≥4 previous miscarriages decreased cumulative live birth rate and increased cumulative clinical pregnancy loss rate in women aged≤37 years old.
目的： 研究既往自然流产次数对不明原因反复妊娠丢失（uRPL）患者胚胎整倍体率和胚胎植入前非整倍体检测（PGT-A）后妊娠结局的影响。 方法： 回顾性选取2015—2021年于山东大学附属生殖医院第1次行PGT-A治疗的不明原因uRPL的女性患者共799例，根据既往自然流产次数分为3组：既往自然流产次数2次（445例）、3次（251例）和≥4次（103例），并按照年龄（≤37岁、>37岁）进行分层分析，在不同年龄组中分别比较3组的胚胎整倍体率、优质囊胚形成率、累积活产率和累积临床妊娠丢失率。采用多因素logistic回归模型分析累积活产率、临床妊娠丢失率和胚胎整倍体率的相关因素。 结果： 患者年龄为（34.7±5.1）岁。≤37岁患者［分别为48.9%（539/1 103）、50.6%（354/700）和52.1%（152/292），P=0.567］和>37岁患者［分别为26.2%（103/393）、28.8%（55/191）和20.5%（16/78），P=0.377］既往自然流产次数2、3和≥4次组间胚胎整倍体率差异均无统计学意义。≤37岁患者中，与既往自然流产次数2和3次组相比，≥4次组累积活产率较低［分别为52.6%（153/291）、52.8%（93/176）和34.3%（25/73），P=0.014］，累积临床妊娠丢失率较高［分别为15.8%（31/196）、15.3%（18/118）和46.9%（23/49），P<0.001］。校正年龄、体质指数、抗苗勒管激素、人绒毛膜促性腺激素日子宫内膜厚度和窦卵泡数后，在≤37岁的患者中，既往流产次数≥4次是累积活产率（OR=0.461，95%CI：0.263~0.807，P=0.007）和累积临床妊娠丢失率（OR=4.382，95%CI：2.165~8.873，P<0.001）的相关因素；在>37岁的患者中，既往流产次数与累积活产率、临床妊娠丢失率和胚胎整倍体率无相关性。 结论： 在uRPL人群中，≥4次自然流产会降低≤37岁患者的累积活产率，增加累积临床妊娠丢失率。.