内异症合并不孕患者体外受精刺激周期超促排卵治疗后妊娠率的影响因素分析  

Study on the factors associated with clinical pregnancy rate of in-vitro fertilization in endometriosis related infertility

作　　者：侯振[1] 冒韵东[1] 刘嘉茵[1] 

机构地区：[1]南京医科大学第一附属医院生殖医学科,210029

出　　处：《中华妇产科杂志》2013年第1期6-10,共5页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金（81200424）;江苏省临床生殖医学中心（创新平台）计划（苏卫科教[2011]12）

摘　　要：目的探讨内异症合并不孕患者接受体外受精（IVF）刺激周期超促排卵治疗后妊娠率的影响因素。方法对2007年1月至2011年12月在南京医科大学第一附属医院生殖医学科因内异症合并不孕接受IVF刺激周期超促排卵治疗的326例患者的326个刺激周期的临床资料进行回顾性分析，根据是否妊娠分为临床妊娠组141例，未妊娠组185例。单因素和多因素logistic回归分析两组患者的基本情况，包括年龄、体质指数（BMI）、窦卵泡计数、基础FSH（bFSH）、CA125及CA199水平、[VF刺激周期前内异症期别和是否手术以及IVF刺激周期超促排卵治疗所采用的方案对妊娠率的影响。结果（1）妊娠率：IVF刺激周期促排卵治疗后妊娠141例，未妊娠185例，妊娠率为43．2％（141／326）。（2）基本情况：两组患者行IVF刺激周期超促排卵治疗前年龄、BMI、bFSH、窦卯泡计数、CA125和CA199水平比较，差异均无统计学意义（P〉0．05）。（3）单因素logistic回归分析结果：326例患者中，不孕年限〈5年者妊娠率为50．O％（87／174），高于不孕年限≥5年者的35．5％（54／152）；I～Ⅱ期内异症患者妊娠率为56．1％（46／82），高于Ⅲ一Ⅳ期患者的42．5％（79／186，内异症分期仅在268例刺激周期超促排卵治疗前接受手术治疗者中比较，因为未手术患者无手术评分）；IVF刺激周期超促排卵治疗前接受手术治疗者的妊娠率为46．6％（125／268），高于未手术治疗者的27．6％（16／58），差异均有统计学意义（P〈0．05）。刺激周期采用长方案者妊娠率为48．2％（79／164），高于短方案者的38．3％（62／162），但两者比较，差异无统计学意义（P=0．075）。（4）多因素logistic回归分析结果：不孕年限〈5年、内异症期别为Ⅰ～Ⅱ期、IVF前进行手术治疗者的妊娠率显著增加（校正OR值和95％CI分别为2．003，1．263～3．1Objective To evaluate the factors associated with clinical pregnancy rate of in-vitro fertilization （IVF） in endometriosis related infertility. Methods Total of 326 patients with endometriosis related infertility undergoing IVF between January 2007 and December 2011 were studied in Department of Reproductive Medicine, First Affiliated Hospital, Nanjing Medical University, retrospectively, which were divided into 141 cases in clinical pregnancy group and 185 cases in non-pregnancy group. Those factors including age, body mass index （BMI）, basic FSH, antral follicle count （AFC）, CAI25 and CAI99, endometriotic stage and history of surgery, stimulation scheme were analyzed by bivariate analysis and muhivariable logistic regression. Results （1） Pregnancy rate： total of 141 pregnant cases and 185 non- pregnant cases treated by IVF were observed, pregnancy rate was 43.2% （141/326）. （2） Basic parameters：there was no statistical difference in age, BMI, basic FSH, AFC, CA125 and CA199 between clinical pregnancy group and non-pregnancy group （ P 〉 O. 05 ）. （ 3 ） Bivariate analysis ： clinical pregnancy rate of 50. 0% （87/174） among patients with infertility year less than five years was significantly higher than 35.5% （54/152） in patients with more than five years. Pregnancy rate of 56. 1% （46/82） in stage I - ]I was significantly higher than 42. 5% （79/186） in stage ]]I- IV. Pregnancy rate of 46.6% （125/268） with history of surgery was significantly higher than 27.6% （16/58） with no history of surgery （P 〈0. 05）. Pregnancy rate of 48.2% （79/164） in long-term scheme was higher than 38. 3% （62/162） in short-term scheme, but there was no significant difference （P = O. 075 ）. （4） Muhivariable logistic regression：clinical pregnancy rate of infertility year with less than 5 years, stage I - 1/, history of surgery proved stage I - lI and stage Ill - IV was significantly higher compared with infertility year more than 5 years, stage I!1 - IV an

关 键 词：受精 体外 子宫内膜异位症 不育 女(雌)性 妊娠率 

分 类 号：R711.6[医药卫生—妇产科学]