生殖医学杂志

目的 评估联用子宫内膜容受性检测(ERT)与胚胎植入前遗传学检测(PGT)技术在反复种植失败(RIF)患者冻融胚胎移植(FET)周期中的应用效果。方法 选取2018年1月至2023年1月在徐州市妇幼保健院生殖医学中心接受FET的RIF患者，根据患者接受的评估检测不同分为4组：接受ERT评估(基于转录组测序的ERT技术模型)后移植经PGT检测筛选的整倍体囊胚RIF患者(联用组，n=138)、均未接受ERT评估和PGT检测移植RIF患者(RIF组，n=324)、仅接受ERT评估后移植RIF患者(ERT组，n=147)和仅接受PGT检测筛选整倍体囊胚移植RIF患者(PGT组，n=121),比较4组患者的基本情况及FET结局，并对RIF患者活产率的影响因素进行Logistic回归分析。结果 95.79%(273/285)接受ERT评估的RIF患者的内膜容受期会推迟1～2 d,根据ERT评估结果相应调整了移植时间。各组患者的FET结果显示，联用组的胚胎种植率、宫内妊娠率、活产率均显著高于PGT组、ERT组与RIF组(P<0.05)。Logistic回归分析结果表明：实施PGT、接受ERT、接受优质囊胚移植、女方年龄4个变量是获得活产的独立影响因素(P<0.05)。结论 联用ERT与PGT是治疗RIF的一次成功尝试，可在单独应用ERT、PGT的基础上进一步改善RIF患者的FET结局。

Objective:The aim of this study was to assess the effects of combined application of endometrial receptivity testing(ERT) and pre-implantation genetic testing(PGT) in patients with repeated implantation failure(RIF) in frozen embryo transfer(FET).Methods:The patients with RIF in FET were recruited in Center for Reproductive Medicine of Xuzhou Maternity and Child Health Care Hospital between January 2018 and January 2023. The patients were divided into four groups according to different evaluation methods: 138 with ERT and PGT(the combined group),324 without ERT or PGT(the RIF group),147 only with ERT(the ERT group),and 121 only with PGT(the PGT group). The basic characteristics and the FET outcome were compared among the four groups. Multivariate logistic regression analysis was used to analyze the independent factors affecting live birth rate of FET.Results:The endometrial receptivity period of most RIF patients was delayed by 1 to 2 days in the combined group and the embryo transfer time was adjusted according to the evaluation result of ERT. The FET results showed that embryo implantation rate(EIR),intrauterine pregnancy rate(IPR) and live birth rate(LBR) in the combined group were significantly higher than those of the PGT group, the ERT group as well as the RIF group(P<0.05). Multivariate logistic regression analysis showed that PGT,ERT,high-quality blastocyst transplantation and female age were the independent factors influencing live birth rate.Conclusions:The combined application of ERT and PGT could improve FET outcomes of RIF patients, which maybe better than the separate application of ERT or PGT.