不孕症患者体外受精-胚胎移植后发生妊娠丢失的影响因素  

Influencing factors of pregnancy loss after in vitro fertilization-embryo transfer in infertile patients

作　　者：吴喆 王康 林悠悠 WU Zhe;WANG Kang;LIN Youyou(Luoyang Maternal and Child Health Hospital,Reproductive Medicine Department,Luoyang 471000 Henan,China;Luoyang Maternal and Child Health Hospital,Medical Genetics and Prenatal Diagnosis Department,Luoyang 471000 Henan,China)

机构地区：[1]洛阳市妇幼保健院生殖医学科,河南洛阳471000 [2]洛阳市妇幼保健院医学遗传与产前诊断科,河南洛阳471000

出　　处：《中国民康医学》2024年第21期15-18,28,共5页Medical Journal of Chinese People’s Health

摘　　要：目的:分析不孕症患者体外受精-胚胎移植(IVF-ET)后发生妊娠丢失的影响因素。方法:选取2021年1月至2023年6月于该院行IVF-ET后妊娠的1179例不孕症患者进行横断面研究,根据是否发生妊娠丢失将其分为发生组与未发生组。采用Logistic回归分析不孕症患者IVF-ET后发生妊娠丢失的影响因素。结果:两组配偶年龄、配偶体质量指数(BMI)、不孕类型、排卵障碍、精子DNA碎片指数、高DNA可染性水平、卵泡刺激素水平、促黄体激素水平、泌乳素水平、孕酮水平、促性腺激素(Gn)治疗总天数、Gn总量、获卵数比较,差异均无统计学意义(P>0.05);发生组年龄>35岁、BMI>28 kg/m^(2)、不孕年限>3年、流产次数≥2次、雌二醇(E_(2))<15.16 pg/mL、睾酮≥0.75 ng/mL、D-二聚体(D-D)≥400 ng/mL、胰岛素抵抗指数(HOMA-IR)≥2、人绒毛膜促性腺激素(HCG)注射日子宫内膜厚度≤8 mm、优质胚胎移植数<3个占比均高于未发生组,差异有统计学意义(P<0.05);Logistic回归分析结果显示,年龄>35岁、BMI>28 kg/m^(2)、不孕年限>3年、流产次数≥2次、E_(2)<15.16 pg/mL、睾酮≥0.75 ng/mL、D-D≥400 ng/mL、HOMA-IR≥2、HCG注射日子宫内膜厚度≤8 mm、优质胚胎移植数<3个均为不孕症患者IVF-ET后发生妊娠丢失的危险因素(OR>1,P<0.05)。结论:年龄>35岁、BMI>28 kg/m^(2)、不孕年限>3年、流产次数≥2次、E_(2)<15.16 pg/mL、睾酮≥0.75 ng/mL、D-D≥400 ng/mL、HOMA-IR≥2、HCG注射日子宫内膜厚度≤8 mm、优质胚胎移植数<3个均为不孕症患者IVF-ET后发生妊娠丢失的危险因素。Objective:To analyze influencing factors of pregnancy loss after in vitro fertilization-embryo transfer(IVF-ET)in infertile patients.Methods:A cross-sectional study was conducted on 1179 infertile patients who were pregnant after IVF-ET in this hospital from January 2021 to June 2023.According to the occurrence of pregnancy loss,they were divided into the occurrence group and the non-occurrence group.Logistic regression was used to analyze the influencing factors of pregnancy loss after IVF-ET in the infertile patients.Results:There were no significant differences in spouse age,spouse body mass index(BMI),infertility type,ovulation disorder,sperm DNA fragmentation index,high DNA stainability level,follicle stimulating hormone level,luteinizing hormone level,prolactin level,progesterone level,total days of gonadotropin(Gn),total amount of Gn and number of oocytes retrieved between the two groups(P>0.05).The proportions of the patients with age>35 years old,BMI>28 kg/m^(2),duration of infertility>3 years,number of abortions≥2,estradiol(E_(2))level<15.16 pg/mL,testosterone level≥0.75 ng/mL,D-dimer level(D-D)≥400 ng/mL,insulin resistance index(HOMA-IR)≥2,endometrial thickness≤8 mm on the day of human chorionic gonadotropin(HCG)injection,and number of high-quality embryo transfer<3 in the occurrence group were higher than those in the non-occurrence group,and the differences were statistically significant(P<0.05).Logistic regression analysis showed that age>35 years,BMI>28 kg/m^(2),duration of infertility>3 years,number of abortions≥2,E_(2) level<15.16 pg/mL,testosterone level≥0.75 ng/mL,D-D level≥400 ng/mL,HOMA-IR≥2,endometrial thickness≤8 mm on the day of HCG injection,and number of high-quality embryo transfer<3 were risk factors for pregnancy loss after IVF-ET in the infertile patients(OR>1,P<0.05).Conclusions:Age>35 years,BMI>28 kg/m^(2),duration of infertility>3 years,number of abortions≥2,E_(2) level<15.16 pg/mL,testosterone level≥0.75 ng/mL,D-D level≥400 ng/mL,HOMA-IR≥2,endometrial

关 键 词：不孕症 体外受精-胚胎移植 妊娠丢失 影响因素 

分 类 号：R714[医药卫生—妇产科学]