既往自然流产次数对首次IVF/ICSI-ET助孕患者妊娠结局的影响  

Influence of the number of previous spontaneous abortions on the pregnancy outcome of patients undergoing IVF/ICSI-ET

作　　者：范晶晶 原芳 程田田 赵华 张翠莲 何巧花 Fan Jingjing;Yuan Fang;Cheng Tiantian;Zhao Hua;Zhang Cuilian;He Qiaohua(Reproductive Center,Henan Provincial People's Hospital,People's Hospital of Henan University,People's Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院、河南大学人民医院、郑州大学人民医院生殖中心,郑州450003

出　　处：《中华生殖与避孕杂志》2023年第8期777-783,共7页Chinese Journal of Reproduction and Contraception

基　　金：河南省科技攻关项目(182102310134)。

摘　　要：目的探讨既往不同自然流产次数对首次体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection and embryo transfer,IVF/ICSI-ET)患者妊娠结局的影响。方法回顾性队列研究分析2010年1月1日至2018年12月31日期间在河南省人民医院生殖中心首次行IVF/ICSI-ET助孕患者的临床资料,共纳入患者12912例,根据既往自然流产次数分为0次组(n=10948)、1次组(n=1506)、2次组(n=345)及≥3次组(n=113)。比较4组患者间的基本资料和助孕后妊娠结局,并通过单因素、分类多因素logistic回归分析探讨既往自然流产次数对IVF/ICSI-ET患者妊娠结局的影响。结果单因素logistic回归分析显示,年龄、不孕年限、既往自然流产次数、子宫内膜厚度、移植胚胎数及移植优质胚胎数均是患者种植率、妊娠率、早期自然流产率和活产率的影响因素(子宫内膜厚度对早期自然流产率影响P=0.002,余均P<0.001);胚胎移植类型、卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、LH/FSH、抗苗勒管激素(anti-Müllerian hormone,AMH)均对患者种植率、妊娠率和活产率有影响(AMH对活产率影响P=0.002,余均P<0.001);体质量指数(body mass index,BMI)是患者早期自然流产率和活产率的影响因素(P=0.006,P=0.002)。分类多因素logistic回归分析显示,调整年龄、BMI、基础性激素(FSH、LH)、LH/FSH、AMH、周期类型、移植胚胎数、移植胚胎类型、移植优质胚胎数、子宫内膜厚度等混杂因素后,以自然流产0次组为参照组,自然流产≥3次组患者的种植率(OR=0.63,95%CI:0.42~0.94,P=0.025)显著性降低;自然流产1次组(OR=1.56,95%CI:1.27~1.93,P<0.001)、2次组(OR=2.28,95%CI:1.61~3.23,P<0.001)和≥3次组(OR=3.32,95%CI:1.89~5.82,P<0.001)患者再次发生早期自然流产的概率逐渐升高,差异均有统计学意义;自然流产1次组(OR=0.80,95%CI:0.71~0.91,P<0.001)、2次组(OR=0.66,95%CI:0.5Objective To explore the effect of previous different spontaneous abortion times on pregnancy outcomes of patients with the first in vitro fertilization/intracytoplasmic sperm injection and embryo transfer(IVF/ICSI-ET).Methods A retrospective cohort study was performed on the clinical data of patients with the first IVF/ICSI-ET in the Reproductive Center of Henan Provincial People's Hospital from January 1,2010 to December 31,2018.A total of 12912 patients were included.According to the number of previous spontaneous abortions,the patients were divided into four groups:zero time group(n=10948),1 time group(n=1506),2 times group(n=345)and≥3 times group(n=113).The basic data of patients and pregnancy outcomes after assisted pregnancy were compared among the four groups,and the influence of the number of previous spontaneous abortions on pregnancy outcomes of IVF/ICSI-ET patients was investigated by univariate and categorical multivariate logistic regression analysis.Results Univariate logistic regression analysis showed that age,infertility duration,previous spontaneous abortion times,endometrial thickness,the numbers of embryos transferred and high-quality embryos transferred were all influencing factors of implantation rate,pregnancy rate,early spontaneous abortion rate and live birth rate(all P<0.001,except for the influence of endometrial thickness on early spontaneous abortion rate P=0.002).The types of embryo transferred,follicle-stimulating hormone(FSH)level,luteinizing hormone(LH)level,LH/FSH,and anti-Müllerian hormone(AMH)level all had effects on the implantation rate,the pregnancy rate,and the live birth rate(all P<0.001,except for the effect of AMH on the live birth rate P=0.002).Body mass index(BMI)was the influencing factor of early spontaneous abortion rate and live birth rate(P=0.006,P=0.002).After adjusting for confounding factors,multiple regression analysis showed that with zero time group as the reference group,the implantation rate of≥3 times group(OR=0.63,95%CI:0.42-0.94,P=0.025)was signif

关 键 词：流产 自然 受精 体外 自然流产率 妊娠结局 

分 类 号：R714.8[医药卫生—妇产科学]