影响高龄女性IVF-ET新鲜周期临床妊娠结局的多因素分析  

Multivariate analysis of clinical pregnancy outcomes of fresh IVF cycle in women with advanced age

作　　者：穆鑫 张娜[1] 王婷[1] 师娟子 MU Xin;ZHANG Na;WANG Ting;SHI Juan-zi(Assisted Reproductive Medicine Center,Northwest Women’s&Children’s Hospital,the Affiliated Hospital of Xi’an Jiaotong University,Xi’An 710061)

机构地区：[1]西安交通大学附属西北妇女儿童医院生殖中心

出　　处：《生殖医学杂志》2020年第3期336-343,共8页Journal of Reproductive Medicine

摘　　要：目的探讨高龄患者体外受精-胚胎移植(IVF-ET)临床妊娠结局的影响因素。方法选取2017年1月至2018年12月于本院行IVF-ET治疗的年龄>35岁的患者968例为研究对象,所有患者均行新鲜周期胚胎移植,根据是否获得临床妊娠分为临床妊娠组(442例)及未妊娠组(526例)两组。回顾性分析患者的临床、实验室及随访资料,采用Logistic回归分析影响高龄女性临床妊娠结局的因素,并分年龄层(36~40岁和≥40岁)探讨影响不同年龄层高龄女性妊娠结局的可能因素。结果临床妊娠组的男、女双方年龄、基础FSH水平显著低于未妊娠组(P均<0.01),原发不孕、行第一周期IVF治疗、女方体重指数(BMI)、基础窦卵泡(AFC)数则显著高于未妊娠组(P均<0.05),长方案及超长方案比例、囊胚移植比例、HCG日内膜厚度亦显著高于未妊娠组(P均<0.05),Gn总剂量、HMG剂量、HCG日LH水平显著低于未妊娠组(P均<0.05);Gn应用时间、HCG日E2水平、获卵数显著高于未妊娠组(P均<0.01)。二元Logistic回归分析结果显示,IVF周期数(OR=0.712,P=0.036)、女方年龄(OR=0.362,P=0.000)、基础FSH(OR=0.960,P=0.030)、基础AFC(OR=1.041,P=0.028)、HCG日内膜厚度(OR=1.084,P=0.008)、获卵数(OR=1.085,P=0.001)为高龄女性不同临床妊娠结局的独立影响因素。年龄分层Logistic回归分析显示,对于36~40岁女性,女方年龄(OR=0.848,P=0.029)、基础AFC(OR=1.050,P=0.005)、卵裂期胚胎/囊胚移植个数(OR=1.809,P=0.001)、是否囊胚移植(OR=1.866,P=0.001)为不同临床妊娠结局的独立影响因素;对于≥40岁女性,女方年龄(OR=0.765,P=0.003)、基础FSH(OR=0.891,P=0.007)、基础AFC数(OR=1.109,P=0.006)为不同临床妊娠结局的独立影响因素。结论高龄女性若存在不孕因素,应尽早进行助孕治疗。根据不同年龄分层,可以调整促排卵方案,获得最大获卵数,选择合适子宫内膜厚度,酌情增加胚胎移植个数,尽量选择囊胚移植以提高临床妊娠率。Objective:To analyze the factors related to clinical pregnancy outcomes of IVF-ET in women with advanced age.Methods:The data of 968 women aged more than 35 years who underwent IVF-ET treatment with fresh embryo transfer in our medical center from January 2017 to December 2018 were collected.The patients were divided into two groups according to the clinical pregnancy result:clinical pregnancy group(n=442)and non-pregnancy group(n=526).The clinical,laboratory and follow-up data of patients were retrospectively analyzed.The factors related to pregnancy outcomes were analyzed by univariate and logistic regression methods.And the women were subdivided to 36-40 years old group and≥40 years old group to explore the possible factors that affect the pregnancy outcomes of elderly women of different ages.Results:The female age,male age and basal FSH in clinical pregnancy group were significantly lower than non-pregnancy group(P<0.01).The proportion of primary infertility and the ratio of the first cycle IVF,body mass index(BMI),basal antral follicle count(AFC)in clinical pregnancy group were significantly higher than non-pregnancy group(P<0.05).The proportion of using long and super-long protocol,blastocyst transfer ratio and endometrial thickness on HCG day in the clinical pregnancy group were significantly higher than those in the non-pregnancy group(P<0.05).The total doses of Gn and HMG,LH on HCG day in clinical pregnancy group significantly lower than non-pregnancy group(P<0.05).The duration of Gn used,estrodiol(E2)on HCG day and number of oocytes retrieved in clinical pregnancy group significantly higher than non-pregnancy group(P<0.05).The logistic regression analysis suggested that number of IVF cycles(OR=0.712,P=0.036),female age(OR=0.362,P=0.000),basal FSH(OR=0.960,P=0.030),basal AFC(OR=1.041,P=0.028),endometrial thickness on HCG day(OR=1.084,P=0.008)and number of retrieved oocytes(OR=1.085,P=0.001)were the independent influencing factors on the clinical pregnancy outcome in IVF-ET cycle in women with advanced

关 键 词：高龄女性 体外受精-胚胎移植 临床妊娠 多因素分析 

分 类 号：R711.6[医药卫生—妇产科学]