体外受精-胚胎移植后反复种植失败的相关因素分析  

Analysis of factors related to repeated implantation failure after in vitro fertilization-embryo transfer

作　　者：郭玲[1,2] 杨芳 郭安良[1] 刘雯 沈彦军 李莉[1] 代彩凤[1] 邓晓惠[1,2] Guo Ling;Yang Fang;Guo Anliang(Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Qilu Hospital of Shandong University,Jinan 250012;Cheeloo College of Medicine,Shandong University,Jinan 250012)

机构地区：[1]山东大学齐鲁医院妇产科生殖医学中心,济南250012 [2]山东大学齐鲁医学院,济南250012

出　　处：《现代妇产科进展》2022年第6期435-439,442,共6页Progress in Obstetrics and Gynecology

摘　　要：目的探讨体外受精/卵细胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)后胚胎反复种植失败(RIF)发生的相关危险因素,为预防和降低RIF的发生寻找临床管理策略。方法回顾性研究2018年8月至2020年2月于山东大学齐鲁医院妇产科生殖医学中心常规行IVF/ICSI治疗的不孕症患者789例,根据胚胎移植后妊娠结局分为RIF组(222例)和正常妊娠组(567例)。比较两组患者的一般临床资料及相关自身免疫抗体等,采用logistic回归分析相关危险因素,绘制ROC曲线评价预测模型价值。结果RIF组的年龄、不孕年限、继发性不孕比例、人工流产次数、基础FSH、宫腔镜检查异常比例均高于对照组,AMH、移植日内膜厚度均低于对照组,差异均有统计学意义(P<0.05)。RIF组的TG-Ab阳性比例、ANA阳性比例、β2-GPΙ-Ab阳性比例均高于对照组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,两组患者的不孕年限(OR=1.098)、继发性不孕比例(OR=1.763)、AMH(OR=0.932)、宫腔镜检查异常比例(OR=1.648)、ANA阳性比例(OR=2.176)、β2-GPΙ-Ab阳性比例(OR=2.682)比较,差异均有统计学意义(P<0.05)。ROC曲线分析结果显示,曲线下面积(AUC)为0.737(95%CI为0.697~0.777,P<0.001)。结论不孕年限增加、继发性不孕、低AMH水平、宫腔镜检查异常、ANA阳性、β2-GPΙ-Ab阳性等因素与RIF密切相关,临床上可综合考虑上述危险因素采取针对性的干预措施,以获得良好的临床妊娠结局。Objective:To explore the risk factors of repeated implantation failure(RIF)after in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET),to provide clinical management strategies to prevent and reduce the occurrence of RIF.Methods:From August 2018 to February 2020,789 infertility patients who underwent IVF/ICSI treatment at the Center for Reproductive Medicine of Qilu Hospital of Shandong University were analyzed retrospectively.According to the pregnancy outcome after embryo transfer,they were divided into RIF group(222 cases)and normal pregnancy group(567 cases).General clinical data and related autoimmune antibody indexes of the two groups of patients were compared,and logistic regression analyses of related risk factors were performed.ROC curve was drawn to evaluate the value of the predictive model.Results:The age,duration of infertility,proportion of secondary infertility,number of artificial abortions,basic FSH levels,and proportion of abnormal hysteroscopy were higher,whereas the AMH levels and endometrial thickness on the day of transplantation were lower in the RIF group compared with those in the control group(P<0.05).Autoimmune antibody indicators:the positive ratios of TG-Ab,ANA andβ2-GPΙ-Ab in the RIF group were higher than those in the control group(P<0.05).The duration of infertility(OR=1.098),proportion of secondary infertility(OR=1.763),AMH(OR=0.932),proportion of abnormal hysteroscopy(OR=1.648),ANA positive ratio(OR=2.176),β2-GPΙ-Ab positive ratio(OR=2.682)were significantly different in the two groups(P<0.05).The area under the curve(AUC)was 0.737(95%CI:0.697~0.777,P<0.001).Conclusion:Long duration of infertility,secondary infertility,low AMH level,abnormal hysteroscopy,ANA positive andβ2-GPΙ-Ab positive are closely related to RIF.The above risk factors should be comprehensively considered in clinical practice and precisely targeted interventions could be taken to reduce RIF risk and obtain better clinical pregnancy outcome.

关 键 词：体外受精-胚胎移植 反复种植失败 LOGISTIC回归 危险因素 

分 类 号：R711.6[医药卫生—妇产科学]