目的 探讨体脂率对进行体外受精/卵胞质内单精子注射(in vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)新鲜周期移植患者妊娠结局的影响.方法 采用回顾性队列研究方法,对2022年3月至2023年10月期间于郑州大学第三附属医院生殖健康医院就诊的20～45岁行IVF/ICSI治疗的患者临床资料进行分析.根据体脂率将研究对象分为非肥胖组(体脂率<35%)800例和肥胖组(体脂率≥35%)742例.比较两组患者基线数据、促排卵结局及新鲜移植周期临床妊娠结局的差异.结果 ①肥胖组患者体质量指数[body mass index,BMI,25.85(24.22,28.04)kg/m2]、基础睾酮[0.80(0.45,1.12)nmol/L]、甘油三酯[1.29(1.03,1.59)mmol/L]、血清总胆固醇[4.55(4.29,4.81)mmol/L]、低密度脂蛋白胆固醇[3.17(2.90,3.40)mmol/L]、空腹葡萄糖[5.40(5.10,5.75)mmol/L]、空腹胰岛素[12.99(9.01,18.31)mU/L]、胰岛素抵抗指数[3.09(2.14,4.50)]、窦卵泡计数[16.00(11.00,22.00)]、合并多囊卵巢综合征占比[9.4%(70/742)]均高于非肥胖组[21.94(20.32,23.51)kg/m2,P<0.001;0.69(0.43,0.98)nmol/L,P<0.001;1.00(0.79,1.21)mmol/L,P<0.001;4.42(4.19,4.66)mmol/L,P<0.001;2.91(2.67,3.15)mmol/L,P<0.001;5.22(5.00,5.45)mmol/L,P<0.001;11.30(8.33,14.82)mU/L,P<0.001;2.61(1.86,3.48),P<0.001;14.00(10.00,20.00),P<0.001;4.8%(38/800),P<0.001];肥胖组基础卵泡刺激素[6.58(5.64,7.73)U/L]、基础雌二醇[133.01(102.35,171.56)pmol/L]、基础黄体生成素[4.80(3.62,6.53)U/L]、高密度脂蛋白胆固醇[1.29(1.17,1.39)mmol/L]均低于非肥胖组[6.91(5.86,8.33)U/L,P<0.001;145.52(105.23,187.95)pmol/L,P=0.001;5.16(3.82,6.94)U/L,P=0.022;1.45(1.36,1.55)mmol/L,P<0.001].②肥胖组患者促性腺激素(gonadotropin,Gn)起始剂量[187.50(150.00,225.00)U]、Gn使用总量[2 481.25(1 856.25,3 225.00)U]均高于非肥胖组[225.00(175.00,250.00)U,P<0.001;2 925.00(2 250.00,3 675.00)U,P<0.001],人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)注射日血雌二醇水平[8 984.00(6 087.75,11 978.25)pmol/L]、hCG注射日黄体生成素水平[1.23(0.87,1.79)U/L]、囊胚形成率[55.56%(33.33%,75.00%)]均低于非肥胖组[9 378.50(6 528.50,12 624.50)pmol/L,P=0.016;1.37(0.94,2.01)U/L,P=0.001;60.00%(37.86%,80.00%),P=0.014].③两组间着床率、临床妊娠率、流产率及活产率差异均无统计学意义(均P>0.05).肥胖组持续妊娠率[41.5%(308/742)]低于非肥胖组[47.6%(381/800),P=0.016].④多因素logistic回归分析显示:体脂率不是临床妊娠率和活产率的独立影响因素(均P>0.05).⑤BMI和体脂率预测获得临床妊娠的受试者工作特征曲线下面积(area under the curve,AUC)分别为0.509与0.518,差异无统计学意义(AUC差值=0.009,95%CI:-0.010～0.028,P=0.376).BMI和体脂率预测获得活产的AUC分别为 0.501与 0.513,差异无统计学意义(AUC差值=0.012,95%CI:-0.007～0.030,P=0.221).结论 高体脂率可增加Gn使用总量,降低囊胚形成率及持续妊娠率.
Effects of body fat percent on outcome of IVF/ICSI in infertile women
Objective To explore the effect of body fat percent(BFP)on assisted reproductive outcomes in infertile women undergoing in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)and fresh embryo transfer.Methods We analyzed clinical data on infertile women in a retrospective cohort study,who underwent IVF/ICSI and embryo transfer at the Reproductive Health Hospital of the Third Affiliated Hospital of Zhengzhou University from March 2022 to October 2023.The study subjects were divided into non-obese group(BFP<35%,800 cases)and obese group(BFP≥35%,742 cases)according to BFP.The baseline data,ovulation induction outcomes and clinical pregnancy outcomes were compared between the two groups.Results 1)The body mass index[BMI,25.85(24.22,28.04)kg/m2],basal testosterone[0.80(0.45,1.12)nmol/L],triglyceride[1.29(1.03,1.59)mmol/L],serum total cholesterol[4.55(4.29,4.81)mmol/L],low-density lipoprotein cholesterol[3.17(2.90,3.40)mmol/L],fasting glucose[5.40(5.10,5.75)mmol/L],fasting insulin[12.99(9.01,18.31)mU/L],homeostasis model assessment-insulin resistance[3.09(2.14,4.50)],antral follicle count[16.00(11.00,22.00)],the patients combined with polycystic ovary syndrome[9.4%(70/742)]in obese group were significantly higher than those in non-obese group[21.94(20.32,23.51)kg/m2,P<0.001;0.69(0.43,0.98)nmol/L,P<0.001;1.00(0.79,1.21)mmol/L,P<0.001;4.42(4.19,4.66)mmol/L,P<0.001;2.91(2.67,3.15)mmol/L,P<0.001;5.22(5.00,5.45)mmol/L,P<0.001;11.30(8.33,14.82)mU/L,P<0.001;2.61(1.86,3.48),P<0.001;14.00(10.00,20.00)mmol/L,P<0.001;4.8%(38/800),P<0.001].Basal follicle-stimulating hormone[6.58(5.64,7.73)U/L],basal estradiol[133.01(102.35,171.56)pmol/L],basal luteinizing hormone[4.80(3.62,6.53)U/L]and high-density lipoprotein cholesterol[1.29(1.17,1.39)mmol/L]in obese group were significantly lower than those in non-obese group[6.91(5.86,8.33)U/L,P<0.001;145.52(105.23,187.95)pmol/L,P=0.001;5.16(3.82,6.94)U/L,P=0.022;1.45(1.36,1.55)mmol/L,P<0.001].2)The initiated dosage of gonadotropin(Gn)used[187.50(150.00,225.00)U]and the total dosage of Gn used[2 481.25(1 856.25,3 225.00)U]in obese group were significantly higher than those in non-obese group[225.00(175.00,250.00)U,P<0.001;2 925.00(2 250.00,3 675.00)U,P<0.001].Serum estradiol level on the day of human chorionic gonadotropin(hCG)injection[8 984.00(6 087.75,11 978.25)pmol/L],luteinizing hormone level on the day of hCG injection[1.23(0.87,1.79)U/L],the rate of blastocyst formation[55.56%(33.33%,75.00%)]in obese group were significantly lower than those in non-obese group[9 378.50(6 528.50,12 624.50)pmol/L,P=0.016;1.37(0.94,2.01)U/L,P=0.001;60.00%(37.86%,80.00%),P=0.014].3)Sustained pregnancy rate in obese group[41.5%(308/742)]was lower than that in non-obese group[47.6%(381/800),P=0.016].The number of embryo transfer,embryo transfer type,implantation rate,clinical pregnancy rate,abortion rate and live birth rate were not statistically significant between the two groups(all P>0.05).4)BFP was not an independent factor of clinical pregnancy rate and live birth rate(all P>0.05).5)The area under the curve(AUC)of BMI and BFP to predict clinical pregnancy was 0.509 and 0.518,and there was no significant difference between them(AUCdifference=0.009,95%CI:-0.010-0.028,P=0.376).The AUC of BMI and BFP for predicting live birth was 0.501 and 0.513,with no statistically significant difference(AUCdifference=0.012,95%CI:-0.007-0.030,P=0.221).Conclusion High BFP can increase total dosage of Gn used,decrease blastocyst formation rate and continuous pregnancy rate.
Embryo transferInfertilityBody fat percentOutcomes of assisted pregnancy
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