冻融胚胎移植前血清雌、孕激素水平在体外受精-胚胎移植治疗中对妊娠结局的影响

Effects of serum estrogen and progesterone levels on pregnancy outcomes before frozen-thawed embryo transfer in vitro fertilization

目的探讨冻融胚胎移植前血清雌、孕激素水平在体外受精-胚胎移植(IVF-ET)治疗中对妊娠结局的影响。方法回顾性分析2017年8月至2018年12月于马鞍山市妇幼保健院行IVF-ET助孕治疗的病人57例68个周期的临床资料,所有病人均接受冻融胚胎移植。记录所有病人的基线资料与妊娠结局并根据不同分组情况[移植前1天雌二醇(Estradiol,E2)水平、移植前1天孕酮(Progesterone,P)水平]并进行比较,行IVF-ET助孕病人临床妊娠的危险因素采用logistic回归分析。结果根据移植前1天E2水平将所有病人分为E2<150pg/mL组22例(27个周期)与E2≥150pg/mL组35例(41个周期)。E2<150pg/mL组病人移植前1天E2水平明显低于E2≥150pg/mL组,种植率31.82%、临床妊娠率37.04%均分别明显低于E2≥150pg/mL组,且早期流产率20.00%明显高于E2≥150pg/mL组(均P<0.05);两组其余基线资料比较均差异无统计学意义(均P>0.05)。根据移植前1天P水平将所有病人分为P<18 ng/mL组24例(30个周期)与P≥18 ng/mL组33例(38个周期)。P<18ng/mL组病人移植前1天P水平明显低于P≥18ng/mL组,种植率34.04%、临床妊娠率36.67%均分别明显低于P≥18ng/mL组,且早期流产率18.18%明显高于P≥18ng/mL组(均P<0.05);两组其余基线资料之间比较均差异无统计学意义(均P>0.05)。以行IVF-ET助孕病人临床妊娠为因变量,对单因素分析中临床妊娠的可能危险因素进行logistic回归分析,结果显示年龄、体质量指数、移植前1天E2、移植前1天P、移植日内膜厚度及稳态模型评估(HOMA)指数HOMA-IR为行IVF-ET助孕病人临床妊娠的独立危险因素(均P<0.05)。结论IVF-ET治疗中冻融胚胎移植前1天血清E2、P水平可预测妊娠结局,且年龄、体质量指数、移植前1天E2和P、移植日内膜厚度及HOMA指数HOMA-IR均为行IVF-ET助孕病人临床妊娠的独立危险因素。

Objective To explore the effects of serum estrogen and progesterone levels on pregnancy outcomes before frozen-thawed embryo transfer in vitro fertilization(IVF-ET).Methods The clinical data of 57 patients with 68 cycles undergoing IVF-ET assisted pregnancy in Maternal and Child Health Care Center of Ma’anshan from August 2017 to December 2018 were retrospectively analyzed.All patients received frozen-thawed embryo transfer.The baseline data and pregnancy outcomes of all patients were recorded and compared according to different groups[estradiol(E2)level and progesterone(P)levels 1 d before transplantation).The logistic regression analysis was used to analyze the risk factors of clinical pregnancy in IVF-ET assisted pregnancy patients.Results According to the level of E21 d before transplantation,all patients were assigned into the E2<150 pg/mL group(n=22,27 cycles)and the E2≥150 pg/mL group(n=35,41 cycles).The E2 level of the E2<150 pg/mL group 1 d before transplantation was significantly lower than that of the E2≥150 pg/mL group.The implantation rate(31.82%)and clinical pregnancy rate(37.04%)were significantly lower than those of the E2≥150 pg/mL group respectively,and the early abortion rate(20.00%)was significantly higher than that of the E2≥150 pg/mL group(all P<0.05).There were no significant difference in the other baseline data between the two groups(all P>0.05).According to the level of P 1 d before transplantation,all patients were assigned into the P<18 ng/mL group(n=24,30 cycles)and the P≥18 ng/mL group(n=33,38 cycles).The P level of the P<18 ng/mL group was significantly lower than that of the P≥18 ng/mL group.The implantation rate(34.04%)and the clinical pregnancy rate(36.67%)were significantly lower than those of the P≥18 ng/mL group,and the early abortion rate(18.18%)was significantly higher than that of the P≥18 ng/mL group(all P<0.05).There were no significant differences in the other baseline data between the two groups(all P>0.05).Regarding the clinical pregnancy of IVF-ET assisted pregnancy patients as dependent variable,logistic regression analysis was carried out on the possible risk factors for clinical pregnancy in univariate analysis.The results showed that age,body mass index,E2 level 1 d before transplantation,P level 1 d before transplantation,intimal thickness on transplantation day and homeostasis model assessment(HOMA)index HOMA-IR were the independent risk factors of clinical pregnancy in IVF-ET assisted pregnancy patients(all P<0.05).Conclusion The serum E2 and P levels 1 d before frozen-thawed embryo transfer in IVF-ET treatment can predict pregnancy outcomes.Age,body mass index,E2 and P levels 1 d before transplantation,intimal thickness on transplantation day and HOMA index HOMA-IR were independent risk factors of clinical pregnancy in IVF-ET assisted pregnancy patients.