体质量指数对卵巢正常反应患者累积分娩率的影响
Impact of BMI on cumulative birth rate in patients with normal ovarian response
刘雯 1冯文娟 2杨阳 1纪昌丽 1晁岚1
作者信息
- 1. 山东大学齐鲁医院妇产科,山东济南 250012
- 2. 济南市中心医院生殖医学科,山东济南 250013
- 折叠
摘要
目的 比较不同体质量指数(body mass index,BMI)对卵巢正常反应患者行体外受精或卵胞浆内单精子注射(in vitro fertilization/intracytoplasmic sperm microinjection,IVF/ICSI)治疗 单个取卵周期胚胎移植累积分娩率(cumulative birth rate,CLBR)的影响.方法 回顾性分析行IVF/ICSI治疗的3 227个取卵周期,根据BMI分为偏瘦组(BMI＜18.5,167个)、正常体质量组(18.5≤BMI＜24.0,2024个)、超重组(24.0≤BMI＜28.0,816个)、肥胖组(BMI≥28.0,220个).分别比较各组患者的临床特征、实验室指标及助孕结局.结果 4组患者随BMI升高,促性腺激素(gonadotrophin,Gn)总量逐渐增加,各组间差异均有统计学意义(P＜0.001);各组间患者获卵数、优胚数、2PN受精率、2PN卵裂率差异均无统计学意义(P＞0.05).肥胖组的优胚率、囊胚形成率均低于正常体质量组(P=0.012,P＜0.001)和超重组(P=0.014,P＜0.001).超重组与肥胖组的卵子利用率均低于正常体质量组患者(P=0.031,P=0.002).超重组的流产率高于正常体质量组(P=0.013).超重组和肥胖组的CLBR均低于正常体质量组(P=0.009,P=0.023).各组间患者的临床妊娠率、早产率差异均无统计学意义(P＞0.05).BMI和CLBR具有显著负相关性,调整后的OR(95％CI)为0.953(0.948～0.958).结论 在进行辅助生殖技术助孕的卵巢正常反应人群中,超重及肥胖导致Gn使用量增加,且肥胖患者的优胚率、囊胚形成率、卵子利用率、取卵周期CLBR明显降低,提示超重肥胖患者积极减重后再进行辅助生殖治疗.
Abstract
Objective To compare the effects of different body mass index(BMI)on the cumulative birth rate(CLBR)in patients with normal ovarian response undergoing in vitro fertilization/intracytoplasmic sperm microinjection(IVF/ICSI).Methods A retrospective analysis of 3,227 oocyte retrieval cycles treated with IVF/ICSI was performed.Patients were divided into low BMI group(BMI＜18.5,n=167),normal BMI group(18.5≤BMI＜24.0,n=2,024),overweight group(24.0≤BMI＜28.0,n=816),and obese group(BMI≥28.0,n=220).Clinical characteristics,labo-ratory indicators and pregnancy outcomes were compared among the groups.Results The total amount of gonadotro-phin(Gn)elevated with increasing BMI in all four groups,with significant difference(P＜0.001).There were no sig-nificant differences in the number of oocytes,number of high-quality embryos,2PN fertilization rate,and 2PN cleavage rate among the four groups(P＞0.05).The high-quality embryo rate and blastocyst formation rate in the obese group were lower than those in the normal BMI group(P=0.012,P＜0.001)and overweight group(P=0.014,P＜0.001).Oocyte utilization was significantly lower in the overweight and obese groups than in the normal BMI group(P=0.031,P=0.002).The miscarriage rate was higher in the overweight group than in the normal BMI group(P=0.013).CLBR was lower in the obese and overweight groups than in the normal BMI group(P=0.009,P=0.023).There were no sig-nificant differences in the clinical pregnancy rate and preterm labor rate among the four groups(P＞0.05).Higher BMI was significantly associated with lower CLBR,and an adjusted OR(95％CI)was 0.953(0.948-0.958).Conclusion In patients with normal ovarian response undergoing assisted reproductive technology,overweight and obesity lead to in-creased total dosage of Gn,and the high-quality embryo rate,blastocyst formation rate,oocyte utilization rate and CLBR are significantly lower in obese patients,indicating that such patients should undergo aggressive weight loss be-fore proceeding to assisted reproduction therapy.
关键词
体质量指数/累积分娩率/体外受精-胚胎移植/肥胖Key words
Body mass index/Cumulative birth rate/In vitro fertilization-embryo transfer/Obesity引用本文复制引用
出版年
2024
NETL
NSTL
万方数据