IVF/ICSI助孕新鲜胚胎移植周期早期妊娠丢失的多因素分析  

Multivariate analysis of early pregnancy loss in fresh IVF/ICSI cycle

作　　者：江欢 潘海燕 曲仕浩[3] 江志宁 徐楗荧[4] JIANG Huan;PAN Hai-yan;QU Shi-hao;JIANG Zhi-ning;XU Jian-ying(Department of Reproductive Endocrinology,Longgang District Maternal&Child Healthcare Hospital of Shenzhen City,Shenzhen 518172;School of Public Health,Guangdong Medical University,Dongguan 523808;Department of Male Reproductive Health,Zhuhai Center for Maternal&Child Health Care,Zhuhai 519000;Reproductive Medicine Center,Zhuhai Center for Maternal&Child Health Care,Zhuhai 519000)

机构地区：[1]深圳市龙岗区妇幼保健院生殖内分泌科,深圳518172 [2]广东医科大学公共卫生学院,东莞523808 [3]珠海市妇幼保健院男性生殖健康科,珠海519000 [4]珠海市妇幼保健院生殖医学中心,珠海519000

出　　处：《生殖医学杂志》2023年第3期344-349,共6页Journal of Reproductive Medicine

基　　金：广东省自然科学基金项目(2019A1515010875)。

摘　　要：目的探讨体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕时新鲜胚胎移植周期中早期妊娠丢失的影响因素。方法回顾性分析2017年9月至2020年12月在珠海市妇幼保健院生殖医学中心接受IVF/ICSI助孕后行新鲜胚胎移植的1009个周期临床资料,根据妊娠结局分为早期流产组(n=165)和活产分娩组(分娩组,n=844)。比较两组患者的一般情况、不同时期激素水平、男方精子质量及胚胎参数,把单因素分析中具有统计学差异的指标进行Logistic回归分析,获得影响早期妊娠丢失的独立因素。结果与分娩组相比,早期流产组女方年龄更大、不孕年限更长、精子前向运动(PR)比例更低、Gn总用量更高,差异均有统计学意义(P<0.05);两组间的受精方式、不孕类型、男方年龄及精子DNA碎片率、女方体质量指数(BMI)、HCG日内膜厚度、女方不同时期(基础、Gn启动日、HCG日)的激素水平、正常受精率、可利用胚胎数及优质胚胎数均无统计学差异(P>0.05)。多因素回归分析显示:女方年龄[OR=0.458,95%CI(0.283,0.742),P=0.001]和不孕年限[OR=0.644,95%CI(0.458,0.905),P=0.011]是IVF/ICSI助孕新鲜胚胎移植周期中早期妊娠丢失的独立影响因素,且女方年龄≤35岁患者分娩成功率是>35岁患者分娩成功率的2.2倍,不孕年限≤3年患者分娩成功率是不孕年限>3年患者分娩成功率的1.6倍。结论女方年龄和不孕年限是影响IVF/ICSI助孕新鲜胚胎移植周期早期妊娠丢失的主要因素,提示对于高龄或者不孕年限3年以上的女性若存在不孕因素,尽早接受辅助生殖技术助孕有助于获得更好的妊娠结局。Objective:To determine the influence factors associated with early pregnancy loss in fresh IVF/ICSI cycle.Methods:The clinical data of 1009 fresh IVF/ICSI cycles at the Reproductive Medicine Center of Zhuhai Maternal and Child Health Hospital from Sep 2017 to Dec 2020 were retrospectively analyzed.The patients were divided into early pregnancy loss(EPL)group(n=165)and live birth(LB)group(n=844)according to the pregnancy outcome.The general condition,hormone levels in different periods,sperm quality and embryo parameters of patients were compared between the two groups.Logistic regression analysis was performed on the indexes with statistical difference in the univariate analysis to obtain the independent factors affecting the loss of early pregnancy.Results:Compared with LB group,the women in the EPL group were older,had longer infertility years,lower proportion of sperm forward movement(PR),and higher total amount of Gn,and the differences were significant(P<0.05).However,there were no significant differences in fertilization mode,infertility type,male age and sperm DNA fragmentation rate,female body mass index(BMI),endometrial thickness on HCG day,female hormone levels in different periods(basic,Gn initial day,HCG day),normal fertilization rate and the numbers of available and high-quality embryos between these two groups(P>0.05).Multivariate regression analysis showed that the female age[OR=0.458,95%CI(0.283,0.742),P=0.001]and infertility duration[OR=0.644,95%CI(0.458,0.905),P=0.011]were the independent influencing factors in fresh IVF/ICSI cycle.In addition,the live birth rate in women aged≤35 years was 2.2 times of that in women aged>35 years.Moreover,the live birth rate in women with infertility durations≤3 years was 1.55 times of that in women with infertility duration>3 years.Conclusions:The female age and infertility duration are the main factors that affect the early pregnancy loss in the assisted fresh embryo transfer cycle of IVF/ICSI.It is suggested that older women who were infertile more than 3

关 键 词：体外受精 卵胞浆内单精子注射 新鲜胚胎移植 早期妊娠丢失 多因素分析 

分 类 号：R711.6[医药卫生—妇产科学]