影响不明原因不孕患者体外受精-胚胎移植妊娠结局的多因素分析  

Multivariate analysis of clinical pregnancy outcomes of IVF-ET in patients with unexplained infertility

作　　者：林琳 刘芸 黄吴健 陈国勇 LIN Lin;LIU Yun;HUANG Wu-jian;CHEN Guo-yong(Fuzhou General Clinical Medical College of Fujian Medical University,Center for Reproductive Medicine,900 th Hospital of Joint Logistcs Support Force,Fuzhou 350025)

机构地区：[1]福建医科大学福总临床医学院联勤保障部队第九○○医院生殖医学中心,福州320025

出　　处：《生殖医学杂志》2022年第9期1203-1208,共6页Journal of Reproductive Medicine

基　　金：军队计生专业科研课题项目(16JS013)。

摘　　要：目的分析不明原因不孕(UI)女性在体外受精/卵胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕过程中临床特征,探讨相关因素对临床结局的影响。方法选取2019年1月-12月在第九○○医院生殖中心首次行IVF/ICSI-ET助孕治疗且年龄<38岁的147例UI患者作为研究对象,选择同时段和同年龄段就诊的输卵管因素(包含轻度的男方因素)不孕患者341例为对照组,两组患者均采用拮抗剂方案。比较两组患者的基本资料、促排卵情况及鲜胚移植临床妊娠率、累积妊娠率和累积活产率,筛选临床认为与UI有关及单因素分析有显著差异的变量行多因素Logistic回归分析,分析UI妊娠结局的影响因素。结果两组患者间的年龄、体质量指数(BMI)、基础生殖激素水平及不孕年限等基本资料均无显著性差异(P>0.05)。与对照组相比,UI组成熟卵率、IVF受精率、囊胚及优质囊胚的形成率均显著降低(P<0.05);UI组的补救ICSI发生率较对照组有增加趋势,但差异尚无统计学意义(P>0.05)。妊娠结局比较结果显示,两组鲜胚移植的临床妊娠率差异无统计学意义(P>0.05),UI组累积妊娠率比对照组(83.67%vs.90.32%)显著降低(P<0.05);UI组累积活产率较对照组有降低趋势,但差异尚未达统计学意义(P>0.05)。校正混杂因素后,多因素Logistic回归分析提示,年龄是影响鲜胚移植临床妊娠的危险因素(P<0.05),年龄>30岁UI患者行鲜胚移植临床妊娠的机会是年龄≤30岁UI患者的0.334倍;移植胚胎数是鲜胚移植临床妊娠的保护因素(OR=3.055,P=0.038),优质囊胚数是UI患者累积活产的保护因素(OR=7.493,P=0.000)。结论UI患者存在潜在的累积活产下降的情况,可能与卵母细胞质量及胚胎发育潜能下降有关。年龄>30岁不利于UI患者鲜胚移植妊娠,增加移植胚胎数有利于鲜胚移植临床妊娠;优质囊胚数是年轻UI患者累积活产良好的预测因子,但如何增加患者优质囊胚数量是�Objective:To analyze the clinical characteristics of w omen with unexplained infertility(UI)during IVF-ET assisted conception,in order to explore the influence of relevant factors on clinical outcomes.Methods:A total of 147 UI patients aged less than 38 years who were treated with IVF-ET for the first time in the Reproductive Center of 900^(th) Hospital from January to December 2019 were selected as subjects,and 341 infertile patients with tubal factors(including mild male factors)in the same period and age were selected as the control group.The patients in both groups were treated with antagonist protocol.The basic data,ovulation induction and clinical pregnancy rate,cumulative pregnancy rate and cumulative live birth rate of fresh embryo transfer were compared between the two groups.The variables clinically considered to be related to UI and significantly different from univariate analysis were screened for multivariate logistic regression analysis to find the influencing factors of UI pregnancy outcome.Results:There were no significant differences in age,body mass index(BMI),basal reproductive hormone levels and infertility years between the two groups(P>0.05).Compared with the control group,the mature oocyte rate,IVF fertilization rate,blastocyst and high-quality blastocyst formation rate were significantly lower in the UI group(P<0.05).The incidence of remedial ICSI tended to increase in the UI group compared with the control group,but there was no significant difference(P>0.05).The comparative results of pregnancy outcomes showed that there was no significant difference in the clinical pregnancy rate of fresh embryo transfer between the two groups(P>0.05).The cumulative pregnancy rate in the UI group was significantly lower in the control group(83.67%vs.90.32%)(P<0.05),and the cumulative live birth rate in the UI group tended to be lower than that in the control group,but it was not significant(P>0.05).After adjusting for confounding factors,multivariate logistic regression analysis showed that age was a ri

关 键 词：不明原因不孕 拮抗剂方案 鲜胚移植 临床妊娠率 累积活产率 

分 类 号：R711.6[医药卫生—妇产科学]