体外受精-胚胎移植后早期妊娠丢失的相关因素分析  

Analysis of factors related to early pregnancy loss in IVF-ET cycles

作　　者：武彩云[1] 张文香[1] 倪丰[1] 周云[1] 姜宏[1] 

机构地区：[1]中国人民解放军第105医院生殖医学中心,安徽合肥230031

出　　处：《中华疾病控制杂志》2016年第5期516-519,529,共5页Chinese Journal of Disease Control & Prevention

基　　金：南京军区医学科技创新重点项目(ZD14)

摘　　要：目的探讨体外受精-胚胎移植后早期妊娠丢失的相关因素。方法回顾性分析体外受精获得妊娠1 720个周期的临床资料,按妊娠结局研究对象分为三组:A组(生化妊娠组)、B组(早期自然流产组)、C组(对照组)。C组为正常分娩或继续妊娠超过3个月者。分析3组患者基本情况、促排卵及体外受精过程对妊娠结局的影响。结果 B组年龄、基础促卵泡激素(basic follicle stimulating hormone,b FSH)水平、≥2次自然流产史高于A组和C组,差异有统计学意义(均有P<0.001);C组人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)注射后雌激素(estrogenic hormone,E2)水平下降率、卵泡晚期添加人绝经期促性腺激素(human menopausal gonadotropin,HMG)剂量及辅助孵化比例低于A组、B组,差异有统计学意义(均有P<0.05)。短方案组早期流产率高于长方案组,差异有统计学意义(P<0.05);子宫内膜异位症患者的早期流产率高于输卵管性不孕因素,差异有统计学意义(P<0.05)。多因素Logistic回归分析,年龄及≥2次自然流产史是早期自然流产的独立风险因素。结论高龄及≥2次自然流产史是体外受精早期自然流产的独立风险因素。Objectives To investigate the factors related to early pregnancy loss in IVF-ET（ in-vitro fertilizationembryo transfer） cycles. Methods The clinical data of 1 720 IVF-ET cycles with pregnancy were analyzed retrospectively. According to pregnancy outcomes,all the subjects were divided into three groups： group A（ biochemical pregnancy group）,group B（ early spontaneous abortion group）,group C（ control）. Group C includes the ones having live birth or ongoing pregnancy more than three months. Comparisons of basic data,process of controlled ovarian hyperstimulation and the outcomes of IVF-ET were performed among three groups. Results The average age of the subjects,basic follicle stimulating hormone（ b FSH） level and ≥ 2 natural abortion history in group B were higher than those in group A and group C,with statistically significant differences（ all P〈0.001）. The ratio of estrogenic hormone（ E2） descends after human chorionic gonadotropin（ h CG） injection,dosage of human menopausal gonadotropin（ HMG） administrated in the late follicular phase and the ratio of received assisted hatching in group C were lower than those in group A and group B,with statistically significant differences（ all P〈0.05）. The early abortion rate in the patients received gonadotropin releasing hormone agonist（ GnRH-a） short protocol was higher than those received GnRH-a long protocol,with statistically significant differences（ P〈0.05）. It was also found that early spontaneous abortion rate in the patients with endometriosis was higher than those with tubal infertility,with statistically significant differences（ P〈0.05）. Logistic regression analysis demonstrated that the age and ≥ 2 natural abortion history were risk factors related to early spontaneous abortion. Conclusions Advanced age and ≥ 2 natural abortion history were both independent risk factors related to early spontaneous abortion.

关 键 词：胚胎移植 胚胎丢失 流行病学方法 

分 类 号：R714.21[医药卫生—妇产科学] R181[医药卫生—临床医学]