首页|自身免疫甲状腺炎对子宫内膜异位症患者胚胎移植结局的影响

自身免疫甲状腺炎对子宫内膜异位症患者胚胎移植结局的影响

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目的:研究自身免疫甲状腺炎(TAI)对子宫内膜异位症(内异症)患者胚胎移植结局的影响。方法:回顾性队列研究。研究对象为2013年1月至2015年12月于北京大学第三医院生殖医学中心进入体外受精-胚胎移植(IVF)周期的曾经行手术治疗明确内异症分期的患者共483例,按照美国生殖医学学会(ASRM)分期,内异症Ⅰ~Ⅱ期患者122例,Ⅲ~Ⅳ期患者361例。在两亚组内分别比较合并TAI与非TAI患者胚胎移植的临床结局。结果:内异症Ⅰ~Ⅱ期患者中,合并TAI组患者33例,非TAI组患者89例,两组间获卵数、优质胚胎率、临床妊娠率、活产率差异均无统计学意义(均P>0.05)。多因素logistic分析提示内异症Ⅰ~Ⅱ期患者中,TSH水平与胚胎移植后活产率呈正相关(OR=1.511,95%CI:1.005~2.274,P<0.05)。内异症Ⅲ~Ⅳ期患者中,合并TAI组有86例,不合并TAI组有275例,两组间获卵数、优质胚胎率、临床妊娠率、活产率差异无统计学意义(均P>0.05)。多因素Logistic分析提示年龄(OR=0.877,95%CI:0.815~0.944,P<0.05)及基础雌二醇E2水平(OR=0.995,95%CI:0.992~0.999,P<0.05)与胚胎移植后活产率呈负相关,同样发现年龄(OR=1.467,95%CI:1.229~1.751,P<0.05)及E2水平(OR=1.008,95%CI:1.000~1.015,P<0.05)与流产率呈正相关。结论:内异症患者中,单因素及多因素分析未提示TAI为IVF周期中影响临床妊娠、流产及活产的相关因素,年龄与其胚胎移植后临床妊娠率、活产率呈负相关,与流产率呈正相关
Effects of autoimmune thyroiditis on embryo transfer outcomes in patients with endometriosis
Objective:To investigate the effect of thyroid autoimmunity (TAI) on embryo transfer outcomes of endometriosis patients after assisted reproductive technology.Methods:This is a retrospective cohort study including 483 patients who underwent surgery for endometriosis staging and entered in-vitro fertilization (IVF) stimulation cycles at the Reproductive Medical Center of Peking University Third Hospital from January 2013 to December 2015. Among them, 122 patients were classified as having American Society for Reproductive Medicine (ASRM) stages Ⅰ-Ⅱ and 361 patients as having stages Ⅲ-Ⅳ. The clinical outcomes of embryo transfer were compared between patients with and without TAI in both subgroups.Results:Among the patients with ASRM stages Ⅰ-Ⅱ endometriosis, there were 33 patients with TAI and 89 without TAI; there were no significant differences in the number of retrieved oocytes, high-quality embryo rate, clinical pregnancy rate, or live birth rate between the two groups (P>0.05 for all). Multivariate logistic analysis showed that TSH levels were positively correlated with live birth rate after embryo transfer in patients with ASRM stages Ⅰ-Ⅱ endometriosis (odds ratio [OR]=1.511, 95% confidence interval [CI]: 1.005-2.274, P<0.05). Among patients with ASRM stages Ⅲ-Ⅳ endometriosis, there were 86 patients with TAI and 275 without TAI; there were no significant differences in the number of retrieved oocytes, high-quality embryo rate, clinical pregnancy rate, or live birth rate between the two groups (P>0.05 for all). Multivariate logistic analysis showed that age (OR=0.877, 95%CI: 0.815-0.944, P<0.05) and baseline E2 levels (OR=0.995, 95%CI: 0.992-0.999, P<0.05) were negatively correlated with live birth rate after embryo transfer, while age (OR=1.467, 95%CI: 1.229-1.751, P<0.05) and baseline E2 levels (OR=1.008, 95%CI: 1.000-1.015, P<0.05) were positively correlated with miscarriage rate in patients with ASRM stages Ⅲ~Ⅳ endometriosis.Conclusions:In patients with endometriosis, single-factor and multi-factor analyses suggest that TAI is not a factor affecting clinical pregnancy, miscarriage, and live birth rates in IVF cycles. Age is negatively correlated with clinical pregnancy and live birth rates, and positively correlated with miscarriage rate after embryo transfer.

王丁然、迟洪滨

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100191 北京,北京大学第三医院生殖医学中心

子宫内膜异位症 甲状腺自身免疫 胚胎移植

国家自然科学基金

8187060761

2023

中华临床医师杂志(电子版)
中华医学会

中华临床医师杂志(电子版)

CSTPCD
影响因子:0.99
ISSN:1674-0785
年,卷(期):2023.17(6)
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