针对前次IVF流产患者冷冻胚胎移植策略的综述：直接移植与PGT-A筛选的深度剖析与循证决策

A Review of Frozen Embryo Transfer Strategies for Patients with Previous IVF Pregnancy Loss: In-depth Analysis and Evidence-Based Decision-Making Regarding Direct Transfer vs. PGT-A Screening

摘要: 经历体外受精(IVF)妊娠丢失并拥有剩余冷冻胚胎的患者面临关键的临床决策。本文系统综述了直接移植与PGT-A筛选两种策略的有效性、安全性及适用人群。多项研究表明，尽管植入前非整倍体遗传学检测(PGT-A)旨在优选整倍体胚胎，但其流程中的胚胎操作损伤与可移植胚胎的绝对减少，可能导致其累积活产率反而低于形态学选择的直接移植策略。此外，复发性流产(RPL)人群的胚胎整倍体率因其病因异质性，显著低于因单基因病行单基因疾病植入前遗传学检测(PGT-M)的人群，这限制了PGT-A在此类人群中的“筛选收益”。本综述整合最新研究，提出了一个基于“获益–损伤–损耗”三角模型的临床决策框架，强调对于多数IVF流产患者，直接移植是追求累积活产的更优策略，而PGT-A的应用应严格限定于经过筛选的特定亚组，并需进行充分的知情同意。

Abstract: Patients who have experienced in vitro fertilization (IVF) pregnancy loss and possess remaining cryopreserved embryos face critical clinical decisions. This article systematically reviews the effectiveness, safety, and applicable populations of two strategies: direct frozen embryo transfer and preimplantation genetic testing for aneuploidy (PGT-A) screening. Multiple studies indicate that although PGT-A aims to select euploid embryos, the procedural manipulations involved in embryo biopsy and the absolute reduction in transferable embryos may result in a lower cumulative live birth rate compared with the direct transfer of morphologically selected embryos. Furthermore, due to etiologic heterogeneity, the euploidy rate in patients with recurrent pregnancy loss (RPL) is significantly lower than in those undergoing preimplantation genetic testing for monogenic disorders (PGT-M), which limits the potential “screening benefit” of PGT-A in this population. Integrating the latest research, this review proposes a clinical decision-making framework based on a “Benefit-Injury-Depletion” triangle model. It emphasizes that, for most IVF patients with prior pregnancy loss, direct embryo transfer is the superior strategy for achieving cumulative live birth, while the application of PGT-A should be strictly limited to carefully selected subgroups and accompanied by thorough informed consent.