身体质量指数对卵巢储备下降病人行新鲜胚胎移植临床结局的影响分析  

Effect of body mass index on clinical outcomes of patients with decreased ovarian reserve undergoing fresh embryo transfer

作　　者：孙晶雪 刘伟 郑娟 郭岩文 任建枝 SUN Jingxue;LIU Wei;ZHENG Juan;GUO Yanwen;REN Jianzhi(Center of Reproductive Medicine,The 73rd Group Military Hospital of the Army,Xiamen,Fujian 361000,China)

机构地区：[1]陆军第七十三集团军医院生殖中心,福建厦门361000

出　　处：《安徽医药》2023年第7期1390-1396,共7页Anhui Medical and Pharmaceutical Journal

基　　金：厦门市医学优势亚专科建设项目(厦卫科教[2018]296号)。

摘　　要：目的了解不同年龄卵巢储备下降(diminished ovarian reserve,DOR)病人行改良长方案体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)/单精子卵胞浆内显微注射(intracytoplasmic sperm injection,ICSI)的临床结局与身体质量指数(body mass index,BMI)的关系。方法回顾性分析2013年1月至2021年12月于陆军第七十三集团军医院行IVF/ICSI新鲜胚胎移植的DOR病人1752例,根据年龄不同分为A组(<35岁)和B组(≥35岁),根据BMI进一步分为3个亚组,即A1(BMI<18.5)、A2(18.5≤BMI<24)、A3(24≤BMI<28)及B1(BMI<18.5)、B2(18.5≤BMI<24)、B3(24≤BMI<28)。分别比较A及B组3个亚组间的一般情况、超促排卵情况、实验室及临床妊娠结局。通过logistic回归分析不同BMI对临床妊娠率的影响。结果超促排卵情况:A1组促性腺激素(gonadotropins,Gn)启动量[225.00(187.50,225.00)IU]及Gn总量[2512.50(2250.00,2775.00)IU]显著低于A2[225.00(225.00,225.00)IU,2700.00(2325.00,2925.00)IU]及A3组[225.00(225.00,225.00)IU,2925.00(2475.00,2925,00)IU];A1组Gn启动时间[30.00(29.00,34.00)d]显著多于A2组[30.00(29.00,33.00)d],A3组人绒毛膜促性腺激素(human chorionic gonadotropin,HCG)日雌二醇水平[1886.00(1067.25,3506.25)μg/L]显著低于A1[2634.00(1698.00,4087.00)μg/L]及A2组[2470.50(1461.00,3746.25)μg/L];B3组Gn总量[2925.00(2662.50,3150.00)IU]显著高于B2组[2700.00(2475.00,3150.00)IU];实验室情况:A2组成熟卵数[7.00(4.00,9.00)个]、可利用胚胎数[4.00(3.00,6.00)个]及优质胚胎数[3.00(1.00,5.00)个]显著高于A1组[6.00(4.00,8.00)个,4.00(2.00,6.00)个,3.00(1.00,4.00)个],B1组可利用胚胎数[3.00(2.00,3.00)个]显著少于B2组[3.00(2.00,5.00)个]及B3组[3.00(2.00,5.50)个];B1组临床妊娠率[33.33%(11/33)]显著低于B3组[56.14%(32/57)]。logistic多因素回归分析显示,校正混杂因素后,BMI对<35岁DOR病人临床妊娠率的影响差异无统计学意义(P>0.05),对≥35岁DOR病人临床妊娠率的影响差异有统计学意义(P<0.05)。≥35Objective To understand the relationship between clinical outcomes and body mass index(BMI)in decreased ovarian reserve(DOR)patients of different ages undergoing modified long protocol in vitro fertilization-embryo transfer(IVF-ET)/intracytoplasmic sperm injection(ICSI).Methods A retrospective analysis was performed on 1752 DOR patients undergoing IVF/ICSI fresh embryo transfer at The 73rd Group Military Hospital of the Army from January 2013 to December 2021.Patiens were assigned into group A(<35 years old)and group B(≥35 years old)according to age,group A and group B were further assigned into 3 subgroups according to body mass index,namely A1(BMI<18.5),A2(18.5≤BMI<24),A3(24≤BMI<28)and B1(BMI<18.5),B2(18.5≤BMI<24),B3(24≤BMI<28).The general conditions,superovulation conditions,laboratory and clinical pregnancy outcomes were compared between the three subgroups of group A and group B,respectively.The effect of different BMI on clinical pregnancy rate was analyzed by Logistic regression.Results Situation of superovulation:the starting amount of Gonadotropins(Gn)[225.00(187.50,225.00)IU]and the total amount of Gn[2512.50(2250.00,2775.00)IU]in group A1 were significantly lower than those in group A2[225.00(225.00,225.00)IU,2700.00(2325.00,2925.00)IU]and A3[225.00(225.00,225.00)IU,2925.00(2475.00,2925.00)IU];the starting time of Gn in group A1[30.00(29.00,34.00)days]significantly more than that in group A2[30.00(29.00,33.00)days].The daily estradiol level of human chorionic gonadotropin(HCG)in group A3[1886.00(1067.25,3506.25)μg/L]was significantly lower than that of group A1[2634.00(1698.00,4087.00)μg/L]and group A2[2470.50(1461.00,3746.25)μg/L];the total Gn amount in group B3[2925.00(2662.50,3150.00)IU]was significantly higher than that in group B2[2700.00(2475.00,3150.00)IU].Laboratory conditions:the number of mature eggs[7.00(4.00,9.00)]and the number of available embryos[4.00(3.00,6.00)]and the number of high-quality embryos[3.00(1.00,5.00)]in group A2 were significantly higher than those in group A

关 键 词：卵巢储备功能 身体质量指数 年龄 改良长方案 体外受精-胚胎移植 

分 类 号：R714.8[医药卫生—妇产科学]