辅助生殖中反复种植失败的相关危险因素分析  

Analysis of risk factors associated with recurrent implantation failure in assisted reproduction technology

作　　者：胡巨伟 郑娟[1] 孟珂 周黎明[1] 李洁[1] HU Ju-wei;ZHENG Juan;MENG Ke;ZHOU Li-ming;LI Jie(Ningbo Women’s&Children’s Hospital,Ningbo 315000)

机构地区：[1]宁波市妇女儿童医院,宁波315000

出　　处：《生殖医学杂志》2023年第10期1510-1515,共6页Journal of Reproductive Medicine

基　　金：浙江省医药卫生项目(2019RC268,2022KY1168);宁波市医疗卫生品牌学科(PPXK2018-06)。

摘　　要：目的探讨辅助生殖技术助孕后反复种植失败(RIF)的相关危险因素,为患者的早期筛查和临床治疗提供参考依据。方法回顾性分析2019年1月至2022年12月在宁波市妇女儿童医院生殖中心行IVF-ET助孕治疗的不孕不育患者临床资料,比较522个RIF周期(RIF组)与935个正常妊娠周期(对照组)患者自身因素和胚胎实验室指标的差异,并采用二元Logistic回归模型分析RIF的危险因素,ROC曲线评价模型的预测价值。结果RIF组女方年龄、HCG日黄体生成素(LH)和孕酮(P)水平、不孕年限与继发不孕比例均显著高于对照组(P<0.05),而原发不孕比例、基础抗苗勒管激素(AMH)水平、HCG日内膜厚度、促性腺激素(Gn)使用天数、Gn总量、HCG日卵泡数、获卵数、卵裂数、受精数及正常受精数、优质胚胎数均显著低于对照组(P<0.05)。二元Logistic回归模型显示,女方年龄(OR=1.095)、不孕年限(OR=1.089)、HCG日子宫内膜厚度(OR=0.600)、HCG日P水平(OR=1.462)和Gn使用天数(OR=0.838)是RIF的显著影响因素(P<0.05);模型的ROC曲线下面积(AUC)为0.808[95%CI(0.783,0.833),P<0.001],提示模型建立良好。结论女性年龄增加、不孕年限增加、HCG日子宫内膜厚度较低、HCG日P水平升高、Gn使用天数较短均是RIF的危险因素,在辅助生殖助孕过程中要特别注意以上因素的改变,做好相应的应对措施,以便获得良好的妊娠结局。Objective:To explore the risk factors of recurrent implantation failure(RIF)in assisted reproduction technology,and provide reference for early screening and clinical treatment of RIF patients.Methods:The clinical data of 522 RIF cycles at the Reproductive Center of Ningbo Women’s&Children’s Hospital from January 2019 to December 2022 were retrospectively analyzed,and compared with 935 cycles of normal pregnancy in terms of patients’own factors and embryonic laboratory indicators.The risk factors of RIF were analyzed by binary logistic regression model,and the predictive value of ROC curve model was evaluated.Results:The female age,the levels of LH and progesterone(P)on HCG day,the duration of infertility and the proportion of secondary infertility in RIF group were significantly higher than those in normal control group(P<0.05).while the proportion of primary infertility,the basic level of anti-Mullerian hormone(AMH),the endometrial thickness on HCG day,the days and total doses of gonadotropin(Gn)used,the numbers of follicles on HCG day,oocytes retrieved,cleavage,fertilization,2PN and high-quality embryos were significantly lower than those in the control group(P<0.05).Binary logistic regression model showed that female age(OR=1.095),infertility duration(OR=1.089),endometrial thickness on HCG day(OR=0.600),P level on HCG days(OR=1.462)and Gn days(OR=0.838)were significant influencing factors of RIF(P<0.05).The area under the ROC curve was 0.808[95%CI(0.783,0.833),P<0.001],indicating that the model was well established.Conclusions:The increased female age and infertility duration,reduced endometrial thickness,higher progesterone level and less Gn days were the risk factors for RIF.In the process of assisted reproduction technology,special attention should be paid to the changes of the above factors,and appropriate countermeasures should be taken to achieve good pregnancy outcome.

关 键 词：体外受精-胚胎移植 辅助生殖技术 反复种植失败 危险因素 临床妊娠 

分 类 号：R711.6[医药卫生—妇产科学]