拮抗剂方案新鲜单囊胚移植患者妊娠失败的独立危险因素分析  

Independent Risk Factors of Pregnancy Failure in Patients with Fresh Single Blastocyst Transfer and GnRH-ant Protocol

作　　者：周文 刘瑜亮[2] 李涛[1] 邢卫杰[1] 张曦亚 欧建平[1] ZHOU Wen;LIU Yu-liang;LI Tao;XING Wei-jie;ZHANG Xi-ya;OU Jian-ping(Reproductive Medicine Center,The Third Affiliated Hospital of Sun Yat-sen University,Guangzhou 510630,China;Center for Reproductive Medicine,The First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510058,China)

机构地区：[1]中山大学附属第三医院生殖医学中心,广东广州510630 [2]中山大学附属第一医院生殖医学中心,广东广州510058

出　　处：《中山大学学报（医学科学版）》2021年第4期596-602,共7页Journal of Sun Yat-Sen University:Medical Sciences

基　　金：广东省自然科学基金(2018A030313370);中山大学临床医学研究5010计划(2016004)。

摘　　要：【目的】探索本中心使用促性腺激素释放激素拮抗剂(GnRH-ant)方案促排后新鲜单囊胚移植患者妊娠失败的独立危险因素。【方法】回顾性分析2017年1月至2020年4月在中山大学附属第三医院生殖医学中心行助孕治疗的325个治疗周期的资料。根据妊娠结局分为临床妊娠组(172例)和未妊娠组(153例),比较两组患者间的基础资料,临床促排卵情况,胚胎发育情况,移植囊胚的分期、内细胞团(ICM)和滋养外胚层(TE)评分,将P<0.1的变量纳入回归方程进行多因素Logistic回归分析,找出临床妊娠失败的独立危险因素。【结果】两组患者间的基础资料差异无统计学意义,促性腺激素(Gn)使用天数(8.9±1.3 vs.8.6±1.2)、人绒毛膜促性腺激素(HCG)注射日的卵泡刺激素(FSH)水平(12.1±3.7 vs.13.0±4.0)U/L、受精方式及移植囊胚的ICM和TE评分在临床妊娠组和未妊娠组的差异有统计学意义。将P<0.1的变量即不孕类型、受精方式、Gn使用天数、HCG注射日FSH水平、HCG注射日黄体生成素(LH)水平和移植囊胚的ICM和TE评分纳入回归模型,采用逐步法分析后发现临床妊娠失败的独立危险因素是移植囊胚的TE评分[P=0.001,OR=2.173,95%CI:(1.359,3.476)]、Gn使用时间[P=0.015,OR=0.794,95%CI:(0.659,0.955)]和受精方式[P=0.024,OR=2.065,95%CI:(1.098,3.882)]。【结论】本中心的数据提示≤40岁预后良好的患者使用拮抗剂促排并行新鲜单囊胚移植时,较差的滋养外胚层评分,较短的Gn使用时间和使用ICSI受精方式是临床妊娠失败的独立危险因素。【Objective】To explore independent risk factors of pregnancy failure in patients with fresh single blastocyst and GnRH-ant protocol.【Methods】Data from 325 IVF treatment cycles performed at the Reproductive Medicine Center of the Third Affiliated Hospital of Sun Yat-sen University from January 2017 to April 2020 were retrospectively analyzed.Patients were assigned to clinical pregnant group(172 cycles)or non-pregnant group(153 cycles).The basic information,stimulation characteristics,embryo development,the degree of blastocoele expansion,the grades of inner cell mass(ICM)and trophectoderm(TE)of the transferred blastocyst were compared.The variables with P<0.1 were included in the logistic regression equation to detect independent risk factors affecting the clinical pregnancy rate.【Results】The basic characteristics of patients were not significantly different between pregnant and non-pregnant group.However,the duration of Gn application(8.9±1.3 vs.8.6±1.2),FSH level on HCG trigger day(12.1±3.7 vs.13.0±4.0)U/L,fertilization method,the grades of ICM and TE of the transferred blastocyst were statistically different between the two groups.When infertility type,fertilization method,duration of Gn,FSH level on HCG trigger day,LH level on HCG trigger day,the grades of ICM and TE of transferred blastocyst were included in the regression model,the independent influence factors were the trophectoderm score of transferred blastocysts[P=0.001,OR=2.173,95%CI:(1.359,3.476)],duration of Gn use[P=0.015,OR=0.794,95%CI:(0.659,0.955)]and fertilization method[P=0.024,OR=2.065,95%CI:(1.098,3.882)].【Conclusion】Our results suggest that poor trophectoderm score,shorter Gn using time and ICSI fertilization method are independent risk factors of clinical pregnancy failure in patients≤40 years old with fresh single blastocyst transfer and GnRH-ant protocol.

关 键 词：单囊胚移植 促性腺激素释放激素拮抗剂 体外受精-胚胎移植 滋养外胚层 卵胞浆内单精子注射 

分 类 号：R714.8[医药卫生—妇产科学]