中心性肥胖对不孕女性体外受精-胚胎移植妊娠结局的影响  

The impact of central obesity on the pregnancy outcomes in infertile women undergoing in vitro fertilization-embryo transfer

作　　者：徐芝慧[1] XU Zhihui(Centre for Reproductive Medicine,the First Affiliated Hospital of Wenzhou Medical University,Wenzhou 325000,China)

机构地区：[1]温州医科大学附属第一医院生殖医学中心,325000

出　　处：《浙江医学》2024年第12期1258-1263,共6页Zhejiang Medical Journal

基　　金：温州市科学技术局基础性医疗卫生科技项目(Y2020493)。

摘　　要：目的探讨中心性肥胖对不孕女性接受体外受精-胚胎移植后的妊娠结局的影响。方法回顾性选取2017年10月至2019年9月在温州医科大学附属第一医院生殖医学中心首次接受体外受精-胚胎移植的2801例不孕女性为研究对象。根据进入治疗周期时的BMI和腰臀比(WHR)分为正常BMI非中心性肥胖组1659例、正常BMI中心性肥胖组654例、肥胖非中心性肥胖组146例和肥胖中心性肥胖组342例,比较4组治疗过程中促性腺激素使用剂量、促排时间、获卵数、可用胚胎数及新鲜胚胎移植妊娠结局。采用多元线性回归分析中心性肥胖对促排周期获得可用胚胎数的影响,多因素logistic回归分析影响患者新鲜胚胎移植能否获得活产的相关因素。应用Kaplan-Meier生存曲线绘制各组单个取卵周期累积活产率。结果与正常BMI非中心性肥胖组相比,肥胖中心性肥胖组促性腺激素使用剂量增加,获卵数和可用胚胎数减少,新鲜胚胎移植后活产率下降,妊娠丢失率增加,单个取卵周期累积活产率下降,差异均有统计学意义(均P<0.05)。多元线性回归分析提示WHR≥0.85显著降低患者促排周期获得的可用胚胎数。不论BMI是否提示肥胖,WHR≥0.85的中心性肥胖女性,其单个取卵周期累积活产率较正常BMI非中心性肥胖组女性下降(均P<0.05)。多因素logistic回归分析发现腰围的增加会使新鲜胚胎移植后活产率降低(OR=0.978,95%CI:0.963~0.992,P=0.003)。Kaplan-Meier生存曲线显示随着胚胎移植周期数增多,4组患者单个取卵周期累积活产率比较差异有统计学意义(P<0.05)。结论中心性肥胖对女性体外受精-胚胎移植的妊娠结局造成不良影响。Objective To investigate the impact of central obesity on the pregnancy outcomes in infertile women undergoing in vitro fertilization-embryo transfer.Methods A total of 2801 infertile women who underwent vitro fertilizationembryo transfer for the first time in the Centre for Reproductive Medicine of the First Affiliated Hospital of Wenzhou Medical University from October 2017 to September 2019 were retrospectively selected as study subjects.Based on their BMI and waist-hip ratio(WHR),patients were divided into 4 groups:normal BMI non-central obesity group(NNCO group,n=1659),normal BMI central obesity group(NCO group,n=654),obese non-central obesity group(ONCO group,n=146),and obese central obesity group(OCO group,n=342).The dosage of gonadotropin,days of ovarian stimulation,number of oocytes retrieved,number of embryos available,and pregnancy outcomes following fresh embryo transfer were compared among the 4 groups.Multiple linear regression was used to analyze the impact of central obesity on the number of available embryos obtained during ovarian stimulation cycle,and multivariate logistic regression was used to analyze the factors affecting live birth following fresh embryo transfer.The Kaplan-Meier survival curve was used to plot the cumulative live birth rate per single egg retrieval cycle.Results Compared with the NNCO group,the OCO group had increased use of gonadotropins,fewer eggs retrieved and embryos available,lower live birth rate after fresh embryo transfer,but increased pregnancy loss rate,with a decreased cumulative live birth rate per single egg retrieval cycle(all P<0.05).Regardless of BMI,the cumulative live birth rates per single egg retrieval cycle of WHR≥0.85 central obese women were lower than that of NNCO group(both P<0.05).Multivariate linear regression analysis indicated that WHR≥0.85 significantly reduced the number of available embryos obtained during the stimulation cycle,and the multivariate logistic regression analysis found that an increased waist circumference would reduce the

关 键 词：体外受精-胚胎移植 腰围 腰臀比 中心性肥胖 

分 类 号：R714.8[医药卫生—妇产科学]