染色体多态性对体外受精-胚胎移植(IVF-ET)结局影响的Meta分析

目的 系统评价染色体多态性对体外受精-胚胎移植(IVF-ET)治疗结果的影响,为提高辅助生殖的成功率提供理论参考。方法 检索PubMed,CNKI等相关中英文数据库,筛选纳入染色体多态性对IVF-ET结局影响的文献,采用Revman 5.3软件进行荟萃分析。结果 最终纳入12项队列研究,共10 457个周期。Meta分析结果显示:染色体多态性会降低IVF-ET受精率(RR=0.97,95%CI:0.96～0.98)和优胚率(RR=0.92,95%CI:0.88～0.97); 但对卵裂率、植入率、妊娠率、流产率及活产率没有影响(RR=0.99,1.00,0.96,0.99和1.13,95%CI:0.97～1.01,0.93～1.08,0.89～1.03,0.79～1.24和0.95～1.34,均P>0.05)。不同授精方式亚组间分析显示:IVF组染色体多态的患者受精率低于对照组,差异有统计学意义(RR=0.77,95%CI:0.71～0.84,P<0.05); ICSI组受精率与染色体多态性不相关(RR=0.98,95%CI:0.95～1.02,P>0.05)。结论 染色体多态性对辅助生殖治疗效果有一定影响,染色体多态性降低了受精率和优质胚胎率。具有染色体变异的不孕夫妇应选择ICSI方案进行助孕治疗。由于所采用研究数量和质量的限制,上述结论需通过更大规模的流行病学调查和研究进一步验证。

Effects of Chromosomal Polymorphism on IVF-ET Outcomes(Meta-Analysis)

Objective To systematically evaluate the effectof chromosome polymorphism on the outcome of in vitro fertilization-embryo transfer(IVF-ET),and provide theoretical reference for improving the success rate of assisted reproduction.Methods PubMed,CNKI and other related Chinese and English databases were retrieved to screen the literaturethat included the influence of chromosomal polymorphism on IVF-ET outcomes.Revmans 5.3 software was used for meta-analysis.Results Finally,12 cohort studies were included,totaling 10 457 cycles.Meta-analysisshowed that chromosomal polymorphism could reduce IVF-ET fertilization rate(RR=0.97,95% CI:0.96～0.98),good quality embryo rate(RR=0.92,95% CI:0.88～0.97),and chromosomal polymorphism had no significant effect on cleavage rate,planting rate,clinical pregnancy rate,early abortion rate and live birth rate(RR=0.99,1.00,0.96,0.99 and 1.13,95%CI:0.97～1.01,0.93～1.08,0.89～1.03,0.79～1.24 and 0.95～1.34,all P>0.05).Inter-subgroup analysis showed that the fertilization rate of IVF patients with chromosome polymorphism was lower than that of the control group(RR=0.77,95%CI:0.71～0.84,P<0.05).Whereas the fertilization rate of ICSI group was not affected bychromosome polymorphism(RR=0.98,95%CI:0.95～1.02,P>0.05).Conclusion Chromosome polymorphism of patients has a certain impact on the outcome of assisted reproductive therapy.Chromosome variation reducedfertilization rate and good embryo rate.Infertile couples with this variant should choose ICSI regimen for assisted pregnancy.However,due to the limitationsof the quantity and quality of the included studies,the above conclusions needto be further validated by larger-scale epidemiological investigations and studies.