高龄女性冻胚移植周期临床妊娠结局的影响因素分析  

Influencing factors on clinical pregnancy outcomes of frozen-thaw embryo transfer cycle in women of advanced age

作　　者：李欣[1] 魏艺 张娟[1] 张娟娟[1] 凌秀凤[1] 赵纯[1] 张媔秋[1] Li Xin;Wei Yi;Zhang Juan;Zhang Juanjuan;Ling Xiufeng;Zhao Chun;Zhang Mianqiu(Reproductive Medicine Center,Women′s Hospital of Nanjing Medical University(Nanjing Women and Children′s Healthcare Hospital),Nanjing 210004,Jiangsu Province,China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)生殖医学中心,南京210004

出　　处：《中华妇幼临床医学杂志（电子版）》2024年第3期276-283,共8页Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)

基　　金：国家自然科学基金资助项目(81971386);江苏省妇幼保健协会科研课题(FYX202204)。

摘　　要：目的探讨影响高龄(分娩年龄≥35岁)女性冷冻胚胎移植(FET)临床妊娠结局的因素。方法选择2018年1月至2020年12月于南京医科大学附属妇产医院生殖中心接受体外受精-胚胎移植(IVF-ET)治疗,采取全胚胎冷冻进行FET,并且35岁<分娩年龄<45岁的1135例不孕患者及其1135个周期为研究对象。采取回顾性分析方法,根据临床妊娠结局,将1135例不孕患者分为妊娠组(n=476,FET后成功妊娠者)和非妊娠组(n=659,FET后未成功妊娠者)。对2组不孕患者血清基础性激素水平、临床妊娠率、囊胚移植率及优质胚胎率等进行统计学分析。对高龄女性FET临床妊娠结局的影响因素分析,采用单因素logistic及多因素非条件logistic回归分析法。采用受试者工作特征(ROC)曲线,评估分娩年龄及血清抗苗勒管激素(AMH)水平对高龄女性FET临床妊娠结局的预测价值。本研究经南京医科大学附属妇产医院伦理委员会批准(审批文号:2020KY-020),所有患者签署临床研究知情同意书。结果①妊娠组不孕患者分娩年龄、血清基础卵泡刺激素(FSH)水平低于非妊娠组,而血清基础AMH水平则高于非妊娠组,并且差异均有统计学意义(P<0.05)。②1135例不孕患者中,35岁<分娩年龄<40岁患者临床妊娠率为50.0%(383/766),显著高于40≤分娩年龄<45岁患者的临床妊娠率(25.2%,93/369),并且差异有统计学意义(χ2=27.60,P<0.001)。③2组不孕患者4个内膜准备方案的患者比例及移植日内膜厚度比较,差异均无统计学意义(P>0.05);妊娠组患者囊胚移植率高于非妊娠组,并且差异有统计学意义(P<0.001)。④多因素非条件logistic回归分析结果显示,患者血清AMH水平高(OR=1.054,95%CI:1.004~1.106,P=0.033),进行囊胚移植(OR=1.981,95%CI:1.524~2.575,P<0.001),均为高龄女性FET妊娠成功的独立保护因素;而40岁≤分娩年龄<45岁(OR=0.469,95%CI:0.349~0.630,P<0.001),则为独立危险因素。⑤妊娠组476例不孕患者中Objective To explore the influencing factors on the clinical pregnancy outcomes of frozen embryo transfer(FET)in women at advanced maternal age(≥35 years old).Methods A total of 1135 cycles of 1135 infertile patients aged 35 years old<delivery age<45 years old from January 2018 to December 2020 who underwent in vitro fertilization-embryo transfer(IVF-ET)cycles and took whole embryo freezing for FET at the Reproductive Medicine Center of the Women′s Hospital of Nanjing Medical University,were selected as research objects.With retrospective analysis,according to clinical pregnancy outcomes,1135 infertile patients were divided into pregnancy group(n=476,successful pregnancy after FET)and non-pregnancy group(n=659,unsuccessful pregnancy after FET).The basal serum sex hormone levels,clinical pregnancy rate,blastocyst transfer rate and high quality embryo rate between two groups were statistically analyzed.Univariate and multivariate logistic regression analysis were used to analyze the influencing factors on clinical pregnancy outcomes of FET in women with advanced age.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of delivery age and serum Mullerian hormone(AMH)level for clinical pregnancy outcomes of FET in women with advanced age.This study was approved by the Ethics Committee of Women′s Hospital of Nanjing Medical University(Approval No.2020KY-020),and all patients signed the informed consent forms for clinical research.Results①The delivery age and basal serum follicle stimulating hormone(FSH)level of infertile patients in pregnancy group were lower than those of in non-pregnancy group,while the basal serum AMH level was higher than that of in non-pregnancy group,and the differences were statistically significant(P<0.05).②Among the 1135 infertile patients in this study,the clinical pregnancy rate of patients with delivery age of over 35 years old and less than 40 years old was 50.0%(383/766),which was significantly higher than that of patients with delivery age

关 键 词：不育 女(雌)性 胚胎移植 体外受精 妊娠结局 影响因素分析 高龄 冻融胚胎移植 

分 类 号：R714[医药卫生—妇产科学]