首页|多囊卵巢综合征患者冻融胚胎移植周期妊娠结局的影响因素分析

多囊卵巢综合征患者冻融胚胎移植周期妊娠结局的影响因素分析

Analysis of pregnancy outcomes after transplantation of frozen-thawed embryo transfer in PCOS patients

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目的 探讨多囊卵巢综合征(PCOS)患者冻融胚胎移植(FET)周期妊娠结局的影响因素.方法 回顾性分析882个FET周期PCOS患者的资料,根据患者的妊娠结局分为未着床组(A组)、流产组(B1 组)和活产组(B2 组).比较这三组患者的临床资料和实验室指标,并使用有序Logistic回归分析冻融胚胎移植后妊娠结局的影响因素.再按照获取优质囊胚数的百分位数(0~3、4~6、7~10、≥11 个)将患者分为C1、C2、C3、C4 组,比较不同优质囊胚数组患者的临床资料及实验室相关指标.结果 882 个PCOS患者移植周期的临床妊娠率 71.09%(627/882),活产率 61.68%(544/882),流产率13.24%(83/627).单因素分析显示,在A、B1和B2 这三组的比较中,体质量指数(BMI)、不孕类型、注射人绒毛膜促性腺激素(hCG)日雌二醇(E2)水平、获卵数和优质囊胚数之间存在显著差异(P<0.05).对五项差异指标进行进一步多元Logistic回归分析显示,BMI(OR=1.046,95%CI:1.001~1.093,P=0.044)和有既往妊娠史(OR=1.417,95%CI:1.030~1.950,P=0.032)是PCOS患者成功妊娠的独立危险因素.A组与B2 组比较:OR=0.920,95%CI:0.880~0.962,P=0.000;B1 组与 B2 组比较:OR=0.923,95%CI:0.862~0.988,P=0.022;而优质囊胚数增多则是妊娠成功的独立保护因素.在优质囊胚数C1-C4 这四组之间比较中,与其他三组相比,C4 组的促性腺激素(Gn)总量最低,获卵数最多(P<0.05).C4 组的BMI、促卵泡生成素(FSH)和极低密度脂蛋白(vLDL)水平较C1 组低,黄体生成素与促卵泡生成素(LH/FSH)比值比C1 组高(P<0.05).C4 组与C3 组相比,空腹胰岛素(FINS)和胰岛素抵抗指数(HOMA-IR)值较低,与C2 和C3 组相比,高密度脂蛋白胆固醇(HDL-C)和载脂蛋白A1(ApoA1)水平较高(P<0.05).结论 BMI、既往妊娠史和优质囊胚数是预测PCOS患者FET周期妊娠结局的独立因素.优质囊胚数更多的患者在FET周期中具有更高的临床妊娠率.
Objective To investigate the factors influencing the pregnancy outcomes during frozen-thawed embryo transfer(FET)cycles in patients with polycystic ovary syndrome(PCOS).Methods A retrospective analysis was conducted on patients'data from 882 FET cycles.According to the pregnancy outcome,the patients were divided into non-implantation group(Group A),abortion group(Group B1)and live birth group(Group B2).Clinical data and laboratory parameters were compared among the three groups,and ordered Logistic regression analysis was used to study the factors influencing pregnancy outcomes after FET.Patients were also divided into four groups(C1-C4)based on the number of high-quality embryos obtained(0-3,4-6,7-10,≥11),and their clinical data and laboratory parameters were compared.Results The clinical pregnancy rate,live birth rate,and miscar-riage rate in the 882 treatment cycles were 71.09%(627/882),61.68%(544/882),and 13.24%(83/627),respectively.Single-factor analysis showed significant differences in body mass index(BMI),infertility type,hu-man chorionic gonadotropin(hCG)day estradiol(E2)level,number of retrieved oocytes,and number of high-quality embryos among Groups A,B1,and B2(P<0.05).Further multiple Logistic regression analysis revealed that BMI(OR=1.046,95%CI:1.001-1.093,P=0.044)and a history of previous pregnancy(OR=1.417,95%CI:1.030-1.950,P=0.032)were independent risk factors for successful FET in PCOS patients,while an in-creased number of high-quality embryos was an independent protective factor for successful pregnancy.Based on the results of Group B2,compared to Group A,OR=0.920,95%CI:0.880-0.962,P=0.000;compared to Group B1,OR=0.923,95%CI:0.862-0.988,P=0.022.Compared with the other three groups(C1-C3),the total amount of gonadotropin(Gn)in the C4 group was the lowest and the number of oocytes obtained was the high-est(P<0.05).Multiple comparisons showed that Group C4 had lower BMI,follicle-stimulating hormone(FSH),very low-density lipoprotein(vLDL)levels,a higher luteinizing hormone and follicle-stimulating hormone(LH/FSH)ratio compared to Group C1(P<0.05).Group C4 had lower fasting insulin(FINS)and homeostasis model assessment of insulin resistance(HOMA-IR)levels compared to Group C3,and higher high-density lipoprotein-cholesterol(HDL-C)and apolipoprotein A1(Apo A1)levels compared to Groups C2 and C3(P<0.05).Con-clusion BMI,the history of previous pregnancy and the number of high-quality embryos were both independent factors for predicting pregnancy outcomes in PCOS patients undergoing FET cycles.Patients with a higher number of high-quality embryos have a higher clinical pregnancy rate during FET cycles.

polycystic ovary syndromefrozen-thawed embryo transferpregnancy outcomeblastocyst cultureprevious pregnancy historyinsulin resistance

向卉芬、张品、徐祖滢、刘振冉、黄悦、黄玉婷、吴琼、李艺冉、李蓉、曹云霞

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安徽医科大学第一附属医院妇产科,合肥 230022

北京大学第三医院妇产科生殖医学中心,北京 100191

国家卫生健康委配子及生殖道异常研究重点实验室,合肥 230032

出生人口健康教育部重点实验室,合肥 230032

生殖健康与遗传安徽省重点实验室,合肥 230032

安徽医科大学第一临床学院,合肥 230032

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多囊卵巢综合征 冻融胚胎移植 妊娠结局 囊胚培养 既往妊娠史 胰岛素抵抗

国家自然科学基金面上项目安徽医科大学校临床科研基金

820716142020xkj182

2024

安徽医科大学学报
安徽医科大学

安徽医科大学学报

CSTPCD北大核心
影响因子:1.095
ISSN:1000-1492
年,卷(期):2024.59(4)
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