PCOS患者胚胎质量以及解冻移植周期妊娠结局的影响因素分析  

Analysis of the influencing factors of embryo quality and pregnancy outcomes in frozen-thawed embryo transfer cycle in polycystic ovary syndrome patients

作　　者：杨泽欣 白雪莲 范亚珍 张印峰[2] 罗海宁[2] 张云山[2] Yang Zexin;Bai Xuelian;Fan Yazhen;Zhang Yinfeng;Luo Haining;Zhang Yunshan(Tianjin Medical University Graduate School,Tianjin 300070,China;Reproductive Medicine Center of Tianjin Central Obstetrics and Gynecology Hospital,Tianjin Key Laboratory of Human Development and Reproductive Regulation,Tianjin 300100,China)

机构地区：[1]天津医科大学研究生院,天津300070 [2]天津市中心妇产科医院生殖医学中心天津市人类发育与生殖调控重点实验室,天津300100

出　　处：《中华生殖与避孕杂志》2022年第4期357-363,共7页Chinese Journal of Reproduction and Contraception

基　　金：天津市人类发育与生殖调控重点实验室开放基金项目(小荷2019XH02)。

摘　　要：目的探索多囊卵巢综合征(polycystic ovary syndrome, PCOS)患者体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection, IVF/ICSI)周期胚胎质量以及冻融胚胎移植(frozen-thawed embryo transfer, FET)周期中妊娠结局的影响因素。方法采用回顾性病例对照研究设计, 分析2015年1月至2019年12月期间于天津市中心妇产科医院生殖医学中心接受IVF/ICSI治疗, 行全胚冷冻治疗并第一次行FET的1233个周期, 根据是否为PCOS患者分为对照组(n=561)和PCOS组(n=672)。比较两组之间患者一般临床资料、实验室相关指标、妊娠结局, 并通过多因素logistic回归分析晚期流产率的影响因素。结果①对照组和PCOS组的一般临床资料中不孕年限[(3.95±2.01)年比(4.84±2.91)年, P=0.007]、体质量指数(body mass index, BMI)[(21.96±2.52)kg/m2比(23.96±3.50)kg/m2, P<0.001]、基础黄体生成素[(4.71±2.38)mU/L比(8.18±5.40)mU/L, P<0.001]、基础雌二醇[(45.49±31.80)ng/L比(56.67±54.17)ng/L, P=0.032]、基础睾酮[(42.80±13.45)ng/L比(53.45±38.67)ng/L, P=0.001]、促性腺激素起始量[(230.80±54.07)U比(192.11±53.79)U, P<0.001]差异均有统计学意义。FET周期中内膜准备方案, PCOS组中更多患者进行了激素替代周期[64.1%(431/672)比26.6%(149/561)], 而对照组更多患者进行了自然周期移植[73.4%(412/561)比35.9%(241/672)], 且差异均有统计学意义(均P<0.001)。②实验室相关指标中获卵数PCOS组大于对照组[(23.36±9.53)枚比(20.32±8.81)枚, P=0.002], PCOS组的优质胚胎数[(2.94±3.13)枚]、优质胚胎率[33.3%(2016/6048)]小于对照组[(4.17±3.65)枚, P=0.034;46.3%(2339/5049), P<0.001], 且差异均有统计学意义。③妊娠结局中, 优质胚胎移植率、生化妊娠率对照组大于PCOS组[71.0%(743/1046)比59.3%(761/1284), P<0.001;7.3%(41/561)比4.5%(30/672), P=0.033], 晚期流产率PCOS组大于对照组[10.3%(43/418)比4.3%(16/326), P=0.002]。④进一步对晚期流产影响因Objective To explore the influencing factors of embryos quality during the cycle of in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)and pregnancy outcomes of frozen-thawed embryo transfer(FET)in patients with polycystic ovary syndrome(PCOS).Methods A retrospective case-control study design was used to analyze patients who received IVF/ICSI treatment at the Reproductive Medicine Center of Tianjin Central Obstetrics and Gynecology Hospital from January 2015 to December 2019,underwent whole embryo cryopreserved and performed the first FET.The 1233 cycles included were divided into control group(n=561)and PCOS group(n=672)according to PCOS diagnosis.The general clinical characteristics,laboratory-related indicators and pregnancy outcomes of patients between the two groups were compared,and the affecting factors of the late miscarriage rate were analyzed by multivariate logistic regression.Results 1)In terms of the general clinical characteristics between the two groups,the differences of duration of infertility[(3.95±2.01)years vs.(4.84±2.91)years,P=0.007],body mass index(BMI)[(21.96±2.52)kg/m2 vs.(23.96±3.50)kg/m2,P<0.001],basal luteinizing hormone[(4.71±2.38)mU/L vs.(8.18±5.40)mU/L,P<0.001],basal estradiol[(45.49±31.80)ng/L vs.(56.67±54.17)ng/L,P=0.032],basal testosterone[(42.80±13.45)ng/L vs.(53.45±38.67)ng/L,P=0.001],gonadortopin initial used dosage[(230.80±54.07)U vs.(192.11±53.79)U,P<0.001]were statistically significant.The endometrium preparation plan in the FET cycle,more PCOS group patients received hormone replacement treatment[64.1%(431/672)vs.26.6%(149/561)],while more patients in control group received natural cycle transplantation[73.4%(412/561)vs.35.9%(241/672)],and the differences were statistically significant(all P<0.001).2)In terms of the laboratory results,the number of oocytes retrieved in PCOS group(23.36±9.53)was higher than that in control group(20.32±8.81,P=0.002).The number of high-quality embryos and the rate of high-quality embryos in PCOS group[2.94±3.13;33

关 键 词：多囊卵巢综合征 胚胎质量 冻融胚胎移植 晚期流产率 

分 类 号：R714.8[医药卫生—妇产科学]