控制体重改善超重和肥胖患者体外受精的临床结局  

Study on weight control to improve clinical outcomes of in vitro fertilization in overweight and obese patients

作　　者：乔洪武[1] 李静[1] 吴佘玲 娄华[1] 王兴玲[1] 管一春[1] QIAO Hongwu;LI Jing;WU Sheling;LOU Hua;WANG Xingling;GUAN Yichun(Reproductive Medicine Centre,The Third Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,CHN)

机构地区：[1]郑州大学第三附属医院生殖医学中心,郑州450000

出　　处：《河南大学学报（医学版）》2022年第2期133-136,共4页Journal of Henan University:Medical Science

基　　金：国家重点研发计划(2016YFC1000200)。

摘　　要：目的:为改善超重和肥胖患者在体外受精中的卵子和胚胎质量、提高临床妊娠率等提供数据基础。方法:回顾性分析2017年1月至2019年12月于郑州大学第三附属医院行IVF/ICSI-ET的超重和肥胖患者139例,每位患者分别行超促排卵2周期,前后2周期均采用长方案行IVF/ICSI,第2周期对体质量进行合理的干预,体质量减少>5%,按减重前后的BMI分为2组。减重前BMI>24 kg/m^(2)。减重后较减重前体质量减少5%以上。使用配对设计的回顾性分析,比较患者体质量干预前后两个周期的体外受精临床结局指标(如获卵数、2PN数及D3可利用胚胎数、临床妊娠率等)。结果:减重前后两组BMI水平的差异具有统计学意义(P<0.001);减重后组行IVF/ICSI的获卵数、2PN数、HCG日E2、D3可利用胚胎数、D3优质胚胎数、囊胚形成率及移植妊娠率均显著优于减重前组(P<0.05);减重后组的周期取消率显著低于减重前组(P=0.028);两组患者Gn总天数和Gn总量的差异无统计学意义(P>0.05)。结论:超重和肥胖患者在进入体外受精周期前应给予合理的体质量干预;合理的体质量干预可以有效地增加卵子数量、提高胚胎质量及临床妊娠率,最终改善临床结局。Objective:To provide data basis for improving the quality of eggs and embryos in vitro fertilization for overweight and/or obese patients,and to improve clinical pregnancy rate.Methods:A retrospective analysis of 139 overweight and/or obese patients who underwent IVF/ICSI-ET in the Third Affiliated Hospital of Zhengzhou University from January 2017 to December 2019.IVF/ICSI was performed according to a long-term protocol.Reasonable weightloss interventions were performed to reduce the body weight by more than 5 % in the second cycle.All the patients was divided into two groups according to BMI before and after weight loss.Retrospective analysis for paired observations was used to compare the clinical outcomes of in vitro fertilization,including the number of eggs obtained,the number of 2 PN,the number offunctional embryos of D3,clinical pregnancy rate,etc.Results:The difference of BMI between before and after weight intervention was statistically significant(P<0.001).Compared with before weight intervention,the number of eggs obtained by IVF/ICSI,the number of 2 PN,the number of embryos available on HCG day E2,D3,and the number of high-quality embryos D3 were significantly increased in patients after weight intervention.The blastocyst formation rate and the pregnancy rate after transplantation were significantly better in patients after weight intervention(P<0.05);The cycle cancellation rate in patients after weight intervention was sigificantly lower than before weight intervention(P=0.028).There was no significant difference in the total Gn days and the total amount of Gn between before and after weight intervention(P>0.05).Conclusion:Effective weight-loss intervention should be performed on overweight and/or obese patients before the IVF cycle.Reasonable weight-loss intervention can effectively increase the number of eggs,improve embryo quality and clinical pregnancy rate,and ultimately improve clinical outcomes.

关 键 词：体质量指数 控制体质量 超重和肥胖 体外受精 

分 类 号：R711.6[医药卫生—妇产科学]