既往自然流产史及相关因素与单次取卵周期累积活产结局的相关性分析  

Correlation analysis between previous spontaneous abortion and related factors and cumulative live birth rate of single ovulation cycle

作　　者：张莹莹 谈际范 张丽梅 严茜 周灿权[1] 王琼[1] Zhang Yingying;Tan Jifan;Zhang Limei;Yan Xi;Zhou Canquan;Wang Qiong(Center of Reproductive Medicine, the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510080)

机构地区：[1]中山大学附属第一医院生殖医学中心,广州510080 [2]中山大学附属第七医院妇产科,深圳518000

出　　处：《新医学》2019年第4期239-243,共5页Journal of New Medicine

基　　金：国家自然科学基金(81170568);广东省自然科学基金(2015A030313192)

摘　　要：目的探讨既往自然流产史与单次取卵周期累积活产(活产)结局的关系。方法收集因输卵管或男方因素就诊的不孕症患者临床资料,分析既往自然流产史及其他因素如年龄、血清抗苗勒管激素(AMH)、卵泡刺激素、黄体生成素、雌二醇、窦卵泡数、BMI、试管周期数、正常受精率、卵裂率和优质胚胎率对活产率的影响。结果共纳入275例患者,与无自然流产组患者相比,自然流产组患者的年龄较高、血清AMH水平较低、窦卵泡数和获卵数较少、再次妊娠的活产率较低(P均<0.05)。年龄(OR=0.912,95%CI 0.849～0.979)、既往自然流产次数(OR=0.579,95%CI 0.402～0.833)和正常受精率(OR=5.933,95%CI 1.503～23.410)与活产率相关(P均<0.05)。在年龄<35岁患者中,无自然流产、偶发自然流产、复发性自然流产患者的活产率比较差异有统计学意义(P <0.05),其中复发性自然流产者的活产率低于无自然流产及偶发自然流产者(P均<0.017)。年龄≥35岁患者中,无自然流产、偶发自然流产、复发性自然流产患者的活产率比较差异无统计学意义(P> 0.05)。无自然流产及偶发自然流产者中,年龄<35岁患者的活产率均高于年龄≥35岁患者(P均<0.01)。结论年龄、既往自然流产次数和正常受精率与活产率有关。在年龄<35岁患者中,复发性自然流产患者的活产率较低。无自然流产及偶发自然流产者中,年龄≥35岁患者活产率较高。Objective To analyze the relationship between previous spontaneous abortion and the cumulative live birth rate of single ovulation cycle. Methods Clinical data of 275 infertile patients due t o uterine tubal or male factors were collected and retrospectively analyzed. The effect of previous spontaneous abortion and other factors including age ,anti-Mullerian hormone( AMH), follicle stimulating hormone( FSH), luteinizing hormone( LH), estradiol( E2), antral follicle count( AFC), body mass index( BMI), number of ovulation cycle, normal fertilization rate, cleavage rate, high-quality D3 embryo rate upon the cumulative live birth rate of single ovulation cycle was evaluated. Results Compared with patients without a history o f spontaneous abortion, those with previous spontaneous abortion were older ,had a lower level of serum AMH , less AFC, less retrieved oocytes and lower live birth rate of secondarpyr egnancy( all P < 0.05). Age( OR = 0.912, 95%CI 0.849-0.979), number of previous spontaneous abortions( OR = 0.579, 95%CI 0.402-0.833) and normal fertilization rate( OR = 5.933, 95%CI 1.503-23.410) were significantly correlated with the live birth rate( all P < 0.05). In patients aged< 35 years ,the live birth rate significantly dffiered among patients with no spontaneous abortion, occasional and recurrent spontaneous abortio(n all P < 0.05). The live birth rate in patients with recurrent spontaneous abortion was significantly lower compared with that in those with no spontaneous abortion and occasional spontaneous abortio(n both P < 0.017). In patients aged ≥35 years, the live birth rate did not significantly differ among patients with no spontaneous abortion ,occasional and recurrent spontaneous abortion( P > 0.05). The liver birth rate of patients aged 3<5 years without spontaneous abortion and with occasional spontaneous abortion was remarkably highert han that of their counterparts aged ≥35 years (both P < 0.01). Conclusions Age, number of previous spontaneous abortion and normal fertilizatoin rate are corre

关 键 词：抗苗勒管激素 早期自然流产 复发性自然流产 活产率 胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]