两类不孕女性行IVF/ICSI-ET术后妊娠结局的影响因素  

Factors affecting pregnancy outcomes after IVF/ICSI-ET in women with tubal factor infertility and polycystic ovary syndrome

作　　者：赵慧敏 王聪 李世军[1,5] 罗罡[2,3] 康颖倩[1,2,3] ZHAO Huimin;WANG Cong;LI Shijun;LUO Gang;KANG Yingqian(Key Laboratory of Environmental Pollution Monitoring and Disease Control of Ministry of Education,School of Public Health,Guizhou Medical University,Guiyang 561113,Guizhou,China;Department of Microbiology,School of Basic Medicine,Guizhou Medical University,Guiyang 561113,Guizhou,China;Key Laboratory of Pathogenic Biology in Guizhou Province,Guiyang 561113,Guizhou,China;Reproductive Medicine Center,Guiyang Maternal and Child Health Hospital,Guiyang 550001,Guizhou,China;Laboratory of Bacterial Disease,Guizhou Provincial Center for Disease Control and Prevention,Guiyang 550004,Guizhou,China)

机构地区：[1]贵州医科大学公共卫生与健康学院&环境污染与疾病监控教育部重点实验室,贵州贵阳561113 [2]贵州医科大学基础医学院微生物学教研室,贵州贵阳561113 [3]贵州省普通高校病原生物学特色重点实验室,贵州贵阳561113 [4]贵阳市妇幼保健院生殖中心,贵州贵阳550001 [5]贵州省疾病预防控制中心细菌科,贵州贵阳550004

出　　处：《贵州医科大学学报》2024年第10期1498-1505,共8页Journal of Guizhou Medical University

基　　金：国家自然科学基金(32060034);高等学校学科创新引智计划(D20009);中-乌政府间科技交流项目(8);贵州省科学技术厅国际科技合作基地(黔科合平台人才〔2020〕4101);贵州省第六批人才基地项目(RCJD2018-22);贵州省高层次创新人才项目(黔科合平台人才-GCC〔2022〕036-1);中国烟草总公司重大科技项目(中烟办〔2021〕150)。

摘　　要：目的探讨输卵管性不孕(TFI)与多囊卵巢综合征(PCOS)不孕症患者行体外受精(IVF)/卵胞浆内单精子注射(ICSI)-胚胎移植(ET)后妊娠结局的相关影响因素。方法选取行IVF/ICSI助孕的TFI和PCOS不孕症患者77例为研究对象,分为TFI组(n=45)和PCOS组(n=32),根据是否发生妊娠分为TFI组妊娠者(n=21)和未妊娠者(n=24)、PCOS组妊娠者(n=10)及未妊娠者(n=22),收集各组不孕症患者的一般临床资料[年龄、文化水平、体质量指数(BMI)、月经周期、既往阴道炎史、不孕类型、不孕年限及既往孕产史];采集各组不孕症患者月经第2~3天静脉血,检测血清中抗苗勒氏管激素(AMH)及基础性激素水平[促卵泡生成素(FSH)、黄体生成素(LH)、雌二醇(E2)、孕酮(P)、催乳素(PRL)及睾酮(T)],并计算FSH/LH;收集各组患者进入IVF/ICSI周期后的促排卵资料[控制性超促排卵(COH)方案、促性腺激素(Gn)总剂量、Gn总天数]及注射人绒毛膜促性腺激素(HCG)日血清FSH、LH、E2、P水平;各组不孕症患者卵泡成熟后取卵,收集实验室相关资料(总获卵数、成熟卵数、受精方式及优质卵数)及移植情况(移植胚胎数量、移植胚胎类型及移植日子宫内膜厚度),并计算成熟卵数占卵子总数比例;行IVF/ICSI助孕4~6周,收集各组ET后的妊娠结局,采用单因素和多因素logistic回归分析影响两类患者妊娠结局的因素。结果PCOS组不孕症患者年龄、Gn总剂量低于TFI组(P<0.05),月经稀发、原发性不孕、孕产史、异位妊娠史、总获卵数及成熟卵数高于TFI组(P<0.05);TFI组不孕症患者中未妊娠者基础P水平低于妊娠者(P<0.05),Gn总剂量、Gn总天数及卵裂期ET比例高于妊娠者(P<0.05);PCOS组不孕症患者中妊娠者的年龄、月经周期正常比例低于TFI妊娠者(P<0.05),基础FSH激素水平、总获卵数及成熟卵数高于TFI组妊娠者(P<0.05);PCOS组不孕症患者中未妊娠者月经周期正常、继发性不孕患者比例低于TObjective To investigate the factors affecting pregnancy outcomes after in vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI)-embryo transfer(ET)in patients with tubal factor infertility(TFI)and polycystic ovary syndrome(PCOS).Methods A total of 77 patients with TFI and PCOS undergoing IVF/ICSI were selected,divided into the TFI group(n=45)and the PCOS group(n=32).They were further subdivided into pregnant and non-pregnant groups:TFI group(pregnant n=21,non-pregnant n=24)and PCOS group(pregnant n=10,non-pregnant n=22).General clinical data[age,education level,body mass index(BMI),menstrual cycle,history of vaginitis,type of infertility,duration of infertility,and past pregnancy history]were collected.On the 2 nd–3 rd day of the menstrual cycle,venous blood samples were taken to measure serum anti-Mullerian hormone(AMH)and basal hormone levels[follicle-stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),progesterone(P),prolactin(PRL),and testosterone(T)].The FSH/LH ratio was calculated.Data on ovarian stimulation[controlled ovarian hyperstimulation(COH)protocol,total dose of gonadotropins(Gn),total days of Gn use]and hormone levels on the day of human chorionic gonadotropin(HCG)injection(FSH,LH,E2,P)were collected.After oocyte retrieval,laboratory data(total number of oocytes retrieved,number of mature oocytes,fertilization method,number of high-quality embryos)and embryo transfer data(number of embryos transferred,type of embryos transferred,endometrial thickness on the day of transfer)were collected.Pregnancy outcomes were assessed 4-6 weeks after ET.Univariate and multivariate logistic regression analyses were used to identify factors affecting pregnancy outcomes.Results The PCOS group had lower age and total dose of Gn than the TFI group(P<0.05),and higher incidence of oligomenorrhea,primary infertility,history of ectopic pregnancy,total number of oocytes retrieved,and number of mature oocytes(P<0.05).In the TFI group,non-pregnant patients had lower basal P levels,higher total dose

关 键 词：体外受精 胚胎移植 多囊卵巢综合征 妊娠结局 不孕症 卵胞浆内单精子注射 输卵管性不孕 

分 类 号：R711.32[医药卫生—妇产科学]