体质量指数与体质量对早卵泡期长效长方案治疗后卵巢反应性的影响

Effect of body mass index and body weight on ovarian response in in vitro fertilization-embryo transfer with early follicular phase long-acting long regimen

目的探讨体质量指数(body mass index,BMI)与体质量对行体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)患者早卵泡期长效长方案促排卵过程中卵巢反应性的影响,指导生殖医生在确定个体化促性腺激素(gonadotropin,Gn)启动剂量时选择更准确的指标。方法回顾性队列研究分析2014年1月至2019年12月期间于江西省妇幼保健院辅助生殖中心行IVF/ICSI-ET治疗时应用早卵泡期长效长方案且Gn启动剂量均为112.5 U的5762例患者临床资料。选择BMI中位1/5人群(BMI范围为20.70~22.03 kg/m^(2)),按照体质量分为低体质量组(<51 kg)、正常体质量组(51~56 kg)、高体质量组(>56 kg),分析三组的卵巢反应性。选择体质量中位1/5患者(体质量范围为52~55 kg),按照BMI大小分为低BMI组(<20.30 kg/m^(2))、正常BMI组(20.30~22.19 kg/m^(2))、高BMI组(>22.19 kg/m^(2)),分析三组的卵巢反应性。结果BMI中位人群按体质量大小分组时,三组Gn总剂量[1612.50(1350.00,1950.00)U比1687.50(1387.50,2100.00)U比1793.75(1443.75,2250.00)U]、人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)扳机日孕酮[0.89(0.60,1.19)μg/L比0.78(0.53,1.05)μg/L比0.69(0.50,0.92)μg/L]与雌激素水平[2569.00(1774.00,3681.00)ng/L比2208.50(1614.00,3020.52)ng/L比2018.00(1385.00,2787.00)ng/L]、IVF正常受精率[66.36%(1539/2319)比66.46%(5460/8216)比62.86%(1281/2038)]、ICSI正常受精率[74.77%(320/428)比78.31%(1368/1747)比71.34%(224/314)]差异均有统计学意义(P=0.006,P<0.001,P<0.001,P=0.008,P=0.014)。通过协方差分析平衡BMI、年龄、窦卵泡计数(antral follicle count,AFC)显示,三组获卵数差异有统计学意义(P=0.022)。体质量中位人群按BMI大小分组时,三组年龄[28(26,31)岁比29(27,32)岁比29(27,32)岁]、Gn使用总量[1725.00(1368.75,2100.00)U比1725.00(1387.50,2100.00)U比1875.00(1425.00,2300.00)U]、IVF正常受精率[66.06%(1775/2687)比65.88%(5689/8635)比62.91%(1589/2526)]、ICSI正常受精率[74.73%(482/645)比77.93%(1511/1939)比67.97%(418/615)]与可利用胚胎数[3.0(2.0,5.0)枚比3.0(2.0,5.0)枚比3.0(2.0,4.0)枚]差异均有统计学意义(P=0.015,P=0.042,P=0.015,P<0.001,P<0.001)。通过协方差分析平衡体质量、年龄、AFC显示,三组获卵数差异无统计学意义(P=0.443)。结论体质量较BMI对卵巢反应性更具有预测价值,建议生殖医生根据体质量而非BMI确定Gn启动剂量。

Objective To explore the effect of body mass index(BMI)and body weight on the ovarian responsiveness of patients undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)treatment with early follicular phase long-acting long regimen,and to instruct reproductive doctors to choose the most accurate indicators when formulating individualized starting dosage of gonadotropin(Gn).Methods A retrospective cohort study analysis of the clinical data of 5762 patients who applied the early follicular phase long-acting long regimen and the Gn starting dosage was 112.5 U during IVF/ICSI-ET treatment at the Assisted Reproductive Center of Jiangxi Maternal and Child Health Hospital from January 2014 to December 2019.Totally 1/5 patients in the middle of BMI(BMI range:20.70-22.03 kg/m^(2))were selected and divided into low weight group(<51 kg),normal weight group(51-56 kg),and high weight group(>56 kg).According to body weight,the ovarian reactivity was analyzed among the three groups.In the same way,1/5 patients in the middle of weight(weight range:52 kg to 55 kg)were divided into low BMI group(<20.30 kg/m^(2)),normal BMI group(20.30-22.19 kg/m^(2)),high BMI group(>22.19 kg/m^(2))and the ovarian reactivity of the three groups was analyzed.Results There were significant differences in total Gn used dosage[1612.50(1350.00,1950.00)U vs.1687.50(1387.50,2100.00)U vs.1793.75(1443.75,2250.00)U],progesterone level[0.89(0.60,1.19)μg/L vs.0.78(0.53,1.05)μg/L vs.0.69(0.50,0.92)μg/L]and estradiol level[2569.00(1774.00,3681.00)ng/L vs.2208.50(1614.00,3020.52)ng/L vs.2018.00(1385.00,2787.00)ng/L]on the day of human chorionic gonadotropin(hCG)injection,IVF normal fertilization rate[66.36%(1539/2319)vs.66.46%(5460/8216)vs.62.86%(1281/2038)]and ICSI normal fertilization rate[74.77%(320/428)vs.78.31%(1368/1747)vs.71.34%(224/314)]among the 1/5 patients in the middle of BMI grouped by body weight(P=0.006,P<0.001,P<0.001,P=0.008,P=0.014).Covariance analysis was used to balance BMI,age and antral follicle count(AFC),and it is found that the number of oocytes retrieved in the three groups was significantly different(P=0.022).However,for the 1/5 patients in the middle of body weight grouped by BMI,there were significant differences in age[28(26,31)years vs.29(27,32)years vs.29(27,32)years],total Gn used dosage[1725.00(1368.75,2100.00)U vs.1725.00(1387.50,2100.00)U vs.1875.00(1425.00,2300.00)U],IVF normal fertilization rate[66.06%(1775/2687)vs.65.88%(5689/8635)vs.62.91%(1589/2526)],ICSI normal fertilization rate[74.73%(482/645)vs.77.93%(1511/1939)vs.67.97%(418/615)]and the number of available embryos[3.0(2.0,5.0)vs.3.0(2.0,5.0)vs.3.0(2.0,4.0)]among the three groups(P=0.015,P=0.042,P=0.015,P<0.001,P<0.001).The results of covariance analysis showed that there was no difference in the number of oocytes retrieved among the three groups after balancing BMI,age and AFC(P=0.443).Conclusion Body weight is more predictive of ovarian responsiveness than BMI.It is recommended that reproductive doctors determine the starting dosage of Gn based on body weight rather than BMI.