BMI对早卵泡期长效长方案IVF/ICSI患者新鲜周期胚胎移植妊娠结局的影响  

Impact of BMI on fresh cycle embryo transfer outcome of IVF/ICSI in patients with early follicular phase prolonged protocol

作　　者：钱易[1] 张婕[1] 蒋春艳[1] 袁纯[1] 张园[1] 刘嘉茵[1] 刁飞扬[1] 马翔[1] Yi Qian;Jie Zhang;Chunyan Jiang;Chun Yuan;Yuan Zhang;Jiayin Liu;Feiyang Diao;Xiang Ma(Department of Reproductive Medicine,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院生殖医学科,210029

出　　处：《中华妇产科杂志》2021年第12期868-875,共8页Chinese Journal of Obstetrics and Gynecology

基　　金：国家自然科学基金(81571403,81701517);江苏省科技厅项目(BK20161067);江苏省妇幼保健协会科研项目(FYX201818)。

摘　　要：目的探究体质指数(BMI)对于进行早卵泡期长效长方案体外受精或卵母细胞胞质内单精子注射法(IVF/ICSI)治疗患者的治疗过程以及新鲜周期胚胎移植妊娠结局的影响。方法回顾性分析2018年1月1日至2020年7月1日于南京医科大学第一附属医院首次行早卵泡期长效长方案的IVF/ICSI治疗患者的临床资料。按照患者的BMI分为低BMI组(BMI<18.5 kg/m^(2),141例)、正常BMI组(18.5≤BMI<24.0 kg/m^(2),1663例)、超重肥胖组(BMI≥24.0 kg/m^(2),453例),分析各组患者的诱导排卵指标有无差异;再从3组中筛选出进行新鲜胚胎移植的患者分别命名为低BMI新鲜组(102例)、正常BMI新鲜组(1266例)、超重肥胖新鲜组(373例),比较各组的诱导排卵情况和妊娠结局。结果本研究共纳入2257例患者,低BMI组、正常BMI组及超重肥胖组患者的促性腺激素(Gn)启动剂量、Gn总天数、Gn总剂量均有显著差异(P均<0.01),超重肥胖组Gn启动剂量[(162±40)U]、Gn总剂量[(2159±668)U]均最多、Gn总天数[(12.3±2.5)d]最长。超重肥胖组hCG日雌二醇及孕酮水平[分别为(7474±4852)pmol/L、(3.4±1.9)nmol/L]均显著低于低BMI组及正常BMI组(P均<0.01),获卵数[(8.4±4.1)个]较正常BMI组减少(P<0.05)。超重肥胖组患者的正常受精数、可移植胚胎数、高评分卵裂期胚胎数均较其他2组略减少,但差异均无统计学意义(P均>0.05)。进行新鲜胚胎移植的1741例患者中,低BMI新鲜组的移植胚胎数[(1.2±0.4)个]较其他2组减少(P<0.05),正常BMI新鲜组患者的生化妊娠率、临床妊娠率、活产率较其他2组增高,但差异均无统计学意义(P均>0.05)。结论在进行早卵泡期长方案lVF/ICSI治疗的患者中,BMI升高可能会影响诱导排卵反应,导致Gn用量增加、Gn诱导排卵的时间延长。虽然不同BMI的各组新鲜周期胚胎移植的妊娠结局尚无统计学差异,但考虑超重、肥胖患者后续妊娠后围产期不良风险增高,故临床工作中对�Objective To investigate the impact of body mass index(BMI)on clinical effect and fresh cycle embryo transfer pregnancy outcome of in vitro fertilization or intracytoplasmic sperm injection(IVF/ICSI)in patients with early follicular phase prolonged protocol.Methods From January 1st,2018 to July 1st,2020,2257 cases of early follicular long-term protocol in IVF/ICSI and embryo transfer were collected using the clinical assisted reproductive technologies management system software database of the First Affiliated Hospital of Nanjing Medical University.Patients were divided into three groups according to the recommended Asian BMI cut-off points:low body mass group(BMI<18.5 kg/m2),normal body mass group(18.5≤BMI<24.0 kg/m2),and high body mass group(BMI≥24.0 kg/m2).The ovarian stimulation characteristics among the groups were investigated.Then 1741 fresh embryo transfer cycles were selected and divided into three groups as above,and then the ovulation induction and clinical outcomes were analyzed among the groups.Results There were significant differences in the starting dosage of gonadotrophin(Gn),total dosage of Gn and days of Gn used among the low body mass group,normal body mass group,and high body mass group in the 2257 IVF/ICSI cycles(all P<0.01).The high body mass group needed the most amount of Gn[(2159±668)U]and longest Gn days[(12.3±2.5)days].The estradiol and progesterone levels[(7474±4852)pmol/L,(3.4±1.9)nmol/L]on hCG trigger day in the high body mass group were lower than those in the low body mass group and normal body mass group(all P<0.01).The oocytes retrieved in high body mass group(8.4±4.1)were significantly lower than normal body mass group(P<0.05).The normal fertilization number,the available embryo number and high quality embryo number were all lower in the high body mass group than other two groups,while no significant difference showed(all P>0.05).In 1741 cycles of fresh embryo transfer,the average number of transplanted embryos in the low body mass group(1.2±0.4)was decreased compared

关 键 词：人体体质指数 胚胎移植 精子注射 细胞质内 体外受精 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]