不明原因不孕女性临床特征和IVF相关指标的回顾性分析  

Analysis of clinical characteristics and IVF related indicators in women with unexplained infertility

作　　者：卜晓萌 贾婵维[1] 马延敏[1] 刘艳君[1] 张巧利[1] 王树玉[1] BU Xiao-meng;JIA Chan-wei;MA Yan-min;LIU Yan-jun;ZHANG Qiao-li;WANG Shu-yu(Department of Reproductive Medicine,Beijing Gynecology and Obstetrics Hospital,Capital Medical University,Beijing 100026)

机构地区：[1]首都医科大学附属北京妇产医院生殖医学科,北京100026

出　　处：《生殖医学杂志》2021年第8期1033-1039,共7页Journal of Reproductive Medicine

基　　金：北京市医院管理中心临床技术创新项目(XMLX202122)。

摘　　要：目的探讨不明原因不孕女性是否存在不同的临床特征及IVF相关指标差异,寻找不明原因不孕的潜在影响因素。方法选取2019年1~5月于我院生殖医学科首次行IVF/ICSI-ET且年龄≤38岁的66例不明原因不孕患者作为研究对象(UI组),选择同时间段就诊且同年龄分布的因输卵管阻塞因素或单纯男性因素不孕患者76例为对照组,比较两组患者的临床基本资料、促排卵、受精及胚胎发育情况的差异。再根据既往是否有妊娠史对两组患者进行亚分组,分别进行上述指标的单因素比较,并将单因素分析P<0.05的变量和临床认为可能与不明原因不孕相关的变量进行多因素Logistic回归分析,筛选不明原因不孕的独立影响因素。结果两组患者基本资料比较,除UI组无既往妊娠史比例显著高于对照组外,其余指标均无显著性差异(P>0.05);两组的促排卵情况及受精与胚胎发育情况均无显著性差异(P>0.05)。亚组分析中,无既往妊娠史不孕患者中UI组的扳机日直径>17 mm卵泡数量[(3±2)vs.(5±2)个]、优质胚胎数[1(0,4)vs.4(2,5)个]和优质胚胎率(44.19%vs.62.71%)均显著低于对照组(P<0.05);多因素Logistic回归分析结果显示,校正混杂因素后基础窦卵泡计数(AFC)[OR=0.790,95%CI(0.702,1.068),P=0.049]、扳机日>17 mm卵泡数[OR=1.172,95%CI(0.550,1.050),P=0.023]及优质胚胎数[OR=0.496,95%CI(0.762,1.488),P=0.039]是无既往妊娠史不明原因不孕的独立影响因素。有既往妊娠史不孕患者中UI组和对照组的基本资料、促排卵情况、胚胎发育情况均无显著性差异(P>0.05);多因素Logistic回归分析结果显示,各项指标均不是有既往妊娠史不明原因不孕的硬性因素。结论潜在的卵巢储备功能下降和胚胎质量下降可能与无既往妊娠史的不明原因不孕相关。Objective:To investigate whether women with unexplained infertility(UI)have different clinical characteristics and IVF-related indicators,and find potential influencing factors related to UI.Methods:A total of 66 unexplained infertile women aged≤38 years,who underwent IVF/ICSI-ET for the first time in our hospital from January to May 2019 were selected as the research subjects(UI group).During the same period,76 age-matched infertile women with fallopian tube obstruction or simple male factor were selected as the controls(the control group).The clinical basic data,ovulation induction status,fertilization and embryo status were compared between the two groups.According to whether the patients had pregnancy history,the patients were subdivided into two groups.The univariate comparison of the above indicators was performed.The variables with P<0.05 in univariate analysis and those considered possibly related to UI in clinic were analyzed by multivariate logistic regression analysis to screen the independent influencing factors of UI.Results:There were no significant differences in basic data,ovulation induction and embryo development status between the two groups(P>0.05).The number of follicles with diameter>17 mm on trigger day[(3±2)vs.(5±2)],the median number of good-quality embryos[1(0,4)vs.4(2,5)]and good-quality embryo rate(44.19%vs.62.71%)in the UI group without pregnancy history were significantly decreased compared with the control group(P<0.05).Multivariate logistic regression analysis showed that antral follicle count(AFC)[OR=0.790,95%CI(0.702,1.068),P=0.049],number of follicles>17 mm on trigger day[OR=1.172,95%CI(0.550,1.050),P=0.023],and number of good-quality embryos[OR=0.496,95%CI(0.762,1.488),P=0.039]were independently influencing factors for UI after adjusting for confounding factors.There were no significant differences in basic data,ovulation induction and embryo status between the two groups with pregnancy history(P>0.05).Conclusions:Potential decreased ovarian reserve function and decreased e

关 键 词：不明原因不孕 窦卵泡计数 卵巢储备 卵巢反应性 

分 类 号：R711.6[医药卫生—妇产科学]