基于广义估计方程探讨剖宫产史对体外受精-胚胎移植患者妊娠结局的影响  

Pregnancy outcomes in women with prior cesarean section undergoing in vitro fertilization:evidence from generalized estimation equation

作　　者：金碧辉[1] 张岭[1] 傅晓华[1] 朱晶[1] 吴香丽[1] 舒静[1] JIN Bihui;ZHANG Ling;FU Xiaohua;ZHU Jing;WU Xiangli;SHU Jing(Department of Reproductive Endocrinology,Zhejiang Provincial People’s Hospital,Hangzhou Medical College,Hangzhou 310014,China)

机构地区：[1]浙江省人民医院(杭州医学院附属人民医院)生殖内分泌科,杭州310014

出　　处：《浙江医学》2020年第23期2495-2500,共6页Zhejiang Medical Journal

基　　金：浙江省自然科学基金项目(LQ19H04005);浙江省医药卫生科技计划项目(2019RC114、2018ZD012)。

摘　　要：目的探讨剖宫产史对体外受精-胚胎移植患者妊娠结局的影响。方法选取2016年1月至2019年4月于浙江省人民医院行体外受精-胚胎移植,且既往有过1次28周以上分娩史的患者342例,根据既往分娩方式分为剖宫产组(CS组,168例,254个移植周期)和经阴道分娩组(VD组,174例,242个移植周期)。采用广义估计方程(GEE)比较两组首个取卵周期所获得胚胎经新鲜或冻融周期移植的临床结局。结果两组患者年龄、不孕年限、BMI、不孕因素等基线资料均衡可比。两组首个取卵周期中所用促性腺激素剂量、促排天数、扳机日雌二醇水平、获卵数、正常受精率、可利用胚胎率及优胚率比较差异均无统计学意义(均P>0.05)。在移植周期中,两组冻融胚胎移植周期占比均约90%,每周期移植胚胎质量、移植日子宫内膜厚度比较亦无统计学差异(均P>0.05)。但CS组移植胚胎数目低于VD组,且困难移植比例高于VD组(均P<0.05)。在GEE模型中,既往剖宫产史对人绒毛膜促性腺激素阳性率、临床妊娠率及活产率的校正前OR值分别为0.60(95%CI:0.42~0.85)、0.62(95%CI:0.43~0.89)及0.59(95%CI:0.41~0.86),差异均有统计学意义(均P<0.05),而在校正年龄、移植胚胎个数及移植胚胎质量等诸多混杂因素后,剖宫产史对上述指标的OR值不再有统计学意义(均P>0.05);且冻融胚胎移植亚组的分析结果也与此一致。结论临床尚不能认为既往剖宫产史会影响体外受精-胚胎移植患者妊娠结局,尤其是冻融胚胎移植。Objective To evaluate the effect of prior cesarean section(CS)on the pregnancy outcomes in women undergoing in vitro fertilization-embryo transfer(IVF-ET).Methods Clinical data of 342 women who had IVF-ET at Zhejiang Provincial People's Hospital between January 2016 and April 2019 with one previous delivery were retrospectively analyzed.There were 168 cases with a prior CS,and 174 cases with a prior vaginal delivery(VD).All the embryos that transferred,either fresh or frozen-thawed,were produced from their first in vitro fertilization cycles,and the pregnancy outcomes were analyzed by generalized estimated equations(GEE).Results Age,infertility duration,BMI,infertility factor,and basal follicle stimulating hormone were all well balanced between the two groups.There were also no significant differences in gonadotropin dose,duration of stimulation,estrogen at trigger day,number of oocytes retrieved,normal fertilization rate,transferable embryo rate,and high-quality embryo rate between two groups(P>0.05).The proportions of frozen-thawed cycles were about 90%in both groups.The quality of embryo transferred per cycle and endometrium thickness on transfer day were also comparable between the two groups(P>0.05).However,the CS group had a significantly lower number of embryos transferred per cycle and a significantly higher rate of difficult embryo transfer compared with VD group(P<0.05).In GEE model,the rates of positive HCG,clinical pregnancy and live birth in CS group were significantly lower than those in VD group,with ORs of 0.60(95%CI:0.42-0.85),0.62(95%CI:0.43-0.89)and 0.59(95%CI:0.41-0.86)respectively(P<0.05).After adjustment for age,the number of embryos transferred per cycle,the quality of the embryo and so on,all the above ORs became non-significant(P>0.05).In the subgroup of frozen-thawed cycles,the effect of a prior CS on pregnancy outcomes remained non-significant.Conclusion Pregnancy outcomes of in vitro fertilization-embryo transfer of CS group are comparable with VD group,especially in the frozen-thawed

关 键 词：体外受精 胚胎移植 剖宫产 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]