| 304 | 9 | 42 |
| 下载次数 | 被引频次 | 阅读次数 |
目的 探讨体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕时新鲜胚胎移植周期中早期妊娠丢失的影响因素。方法 回顾性分析2017年9月至2020年12月在珠海市妇幼保健院生殖医学中心接受IVF/ICSI助孕后行新鲜胚胎移植的1 009个周期临床资料，根据妊娠结局分为早期流产组(n=165)和活产分娩组(分娩组，n=844)。比较两组患者的一般情况、不同时期激素水平、男方精子质量及胚胎参数，把单因素分析中具有统计学差异的指标进行Logistic回归分析，获得影响早期妊娠丢失的独立因素。结果 与分娩组相比，早期流产组女方年龄更大、不孕年限更长、精子前向运动(PR)比例更低、Gn总用量更高，差异均有统计学意义(P<0.05);两组间的受精方式、不孕类型、男方年龄及精子DNA碎片率、女方体质量指数(BMI)、HCG日内膜厚度、女方不同时期(基础、Gn启动日、HCG日)的激素水平、正常受精率、可利用胚胎数及优质胚胎数均无统计学差异(P>0.05)。多因素回归分析显示：女方年龄[OR=0.458,95%CI(0.283,0.742),P=0.001]和不孕年限[OR=0.644,95%CI(0.458,0.905),P=0.011]是IVF/ICSI助孕新鲜胚胎移植周期中早期妊娠丢失的独立影响因素，且女方年龄≤35岁患者分娩成功率是>35岁患者分娩成功率的2.2倍，不孕年限≤3年患者分娩成功率是不孕年限>3年患者分娩成功率的1.6倍。结论 女方年龄和不孕年限是影响IVF/ICSI助孕新鲜胚胎移植周期早期妊娠丢失的主要因素，提示对于高龄或者不孕年限3年以上的女性若存在不孕因素，尽早接受辅助生殖技术助孕有助于获得更好的妊娠结局。
Abstract：Objective:To determine the influence factors associated with early pregnancy loss in fresh IVF/ICSI cycle.Methods:The clinical data of 1 009 fresh IVF/ICSI cycles at the Reproductive Medicine Center of Zhuhai Maternal and Child Health Hospital from Sep 2017 to Dec 2020 were retrospectively analyzed. The patients were divided into early pregnancy loss(EPL)group(n=165) and live birth(LB) group(n=844) according to the pregnancy outcome. The general condition, hormone levels in different periods, sperm quality and embryo parameters of patients were compared between the two groups. Logistic regression analysis was performed on the indexes with statistical difference in the univariate analysis to obtain the independent factors affecting the loss of early pregnancy.Results:Compared with LB group, the women in the EPL group were older, had longer infertility years, lower proportion of sperm forward movement(PR),and higher total amount of Gn, and the differences were significant(P<0.05). However, there were no significant differences in fertilization mode, infertility type, male age and sperm DNA fragmentation rate, female body mass index(BMI),endometrial thickness on HCG day, female hormone levels in different periods(basic, Gn initial day, HCG day),normal fertilization rate and the numbers of available and high-quality embryos between these two groups(P>0.05). Multivariate regression analysis showed that the female age [OR=0.458,95%CI(0.283,0.742),P=0.001] and infertility duration [OR=0.644,95%CI(0.458,0.905),P=0.011] were the independent influencing factors in fresh IVF/ICSI cycle. In addition, the live birth rate in women aged ≤35 years was 2.2 times of that in women aged >35 years. Moreover, the live birth rate in women with infertility durations ≤3 years was 1.55 times of that in women with infertility duration >3 years. Conclusions:The female age and infertility duration are the main factors that affect the early pregnancy loss in the assisted fresh embryo transfer cycle of IVF/ICSI. It is suggested that older women who were infertile more than 3 years should receive assisted reproductive technology as early as possible, which can help to achieve better pregnancy outcomes.
[1] Vitez SF,Forman EJ,Williams Z.Preimplantation genetic diagnosis in early pregnancy loss[J].Semin Perinatol,2019,43:116-120.
[2] Quenby S,Gallos ID,Dhillon-Smith RK,et al.Miscarriage matters:the epidemiological,physical,psychological,and economic costs of early pregnancy loss[J].Lancet,2021,397:1658-1667.
[3] Cai H,Mol BW,Gordts S,et al.Early and late pregnancy loss in women with polycystic ovary syndrome undergoing IVF/ICSI treatment:a retrospective cohort analysis of 21 820 pregnancies[J].BJOG,2021,128:1160-1169.
[4] Yang AM,Xu X,Han Y,et al.Risk factors for different types of pregnancy losses:analysis of 15,210 pregnancies after embryo transfer[J].Front Endocrinol(Lausanne),2021,12:683236.
[5] Agenor A,Bhattacharya S.Infertility and miscarriage:common pathways in manifestation and management[J].Womens Health(Lond),2015,11:527-541.
[6] Carosso AR,van Eekelen R,Revelli A.Women in advanced reproductive age:are the follicular output rate,the follicle-oocyte index and the ovarian sensitivity index predictors of live birth in an IVF cycle[J].J Clin Med,2022,11:859.
[7] LA Marca A,Capuzzo M,Imbrogno MG,et al.The complex relationship between female age and embryo euploidy[J].Minerva Obstet Gynecol,2021,73:103-110.
[8] Bar-Hava I,Ferber A,Ashkenazi J,et al.Does female age affect embryo morphology[J].Gynecol Endocrinol,1999,13:371-374.
[9] Lee TH,Chen CD,Tsai YY,et al.Embryo quality is more important for younger women whereas age is more important for older women with regard to in vitro fertilization outcome and multiple pregnancy[J].Fertil Steril,2006,86:64-69.
[10] Kushnir VA,Frattarelli JL.Aneuploidy in abortuses following IVF and ICSI[J].J Assist Reprod Genet,2009,26:93-97.
[11] Márquez C,Sandalinas M,Bah?e M,et al.Chromosome abnormalities in 1255 cleavage-stage human embryos[J/OL].Reprod Biomed Online,2000,1:17-26.
[12] Cai QF,Wan F,Huang R,et al.Factors predicting the cumulative outcome of IVF/ICSI treatment:a multivariable analysis of 2450 patients[J].Hum Reprod,2011,26:2532-2540.
[13] Lintsen AM,Eijkemans MJ,Hunault CC,et al.Predicting ongoing pregnancy chances after IVF and ICSI:a national prospective study[J].Hum Reprod,2007,22:2455-2462.
[14] Wang AC,Wang Y,Wu FX,et al.Assessing predictors for the success of GnRH antagonist protocol in reproductive women in IVF/ICSI - in fresh cycles[J].Biomed Rep,2017,7:482-486.
[15] Buckett W,Sierra S.The management of unexplained infertility:an evidence-based guideline from the Canadian Fertility and Andrology Society[J/OL].Reprod Biomed Online,2019,39:633-640.
[16] Yilmaz T,Yazici S,Benli T.Factors associated with infertility distress of infertile women:a cross-sectional study[J].J Psychosom Obstet Gynaecol,2020,41:275-281.
[17] Friedler S,Meltzer S,Saar-Ryss B,et al.An upper limit of gonadotropin dose in patients undergoing ART should be advocated[J].Gynecol Endocrinol,2016,32:965-969.
[18] Zhuang J,Li H,Li X,et al.The incidence of unexpected poor ovarian response in Chinese young women[J].Medicine (Baltimore),2019,98:e14379.
[19] Wang N,Zhu Q,Ma M,et al.Comparison of a progestin-primed ovarian stimulation protocol with a flexible GnRH antagonist protocol in patients with polycystic ovary syndrome who are participating in an IVF programme:study protocol for a randomised controlled trial[J].BMJ Open,2020,10:e038153.
[20] 杨海燕，叶碧绿，林文琴，等.体外受精-胚胎移植后早期妊娠丢失相关因素分析[J].生殖医学杂志，2008,17:335-338.
[21] 曲仕浩，罗英，周益平，等.精子DNA碎片指数对体外受精胚胎及囊胚发育的影响[J].生殖医学杂志，2021,30:1650-1652.
[22] Kumari S,Salian SR,Rao A,et al.Quinoline derivative enhances human sperm motility and improves the functional competence[J].Reprod Sci,2021,28:1316-1332.
[23] Mazzilli R,Cimadomo D,Vaiarelli A,et al.Effect of the male factor on the clinical outcome of intracytoplasmic sperm injection combined with preimplantation aneuploidy testing:observational longitudinal cohort study of 1,219 consecutive cycles[J].Fertil Steril,2017,108:961-972.
基本信息:
中图分类号:R714.8
引用信息:
[1]江欢,潘海燕,曲仕浩,等.IVF/ICSI助孕新鲜胚胎移植周期早期妊娠丢失的多因素分析[J].生殖医学杂志,2023,32(03):344-349.
基金信息:
广东省自然科学基金项目(2019A1515010875)
2022-08-11
2022
2022-10-02
2023-02-07
2023
1
2023-03-15
2023-03-15