体外受精-胚胎移植后早期妊娠丢失相关因素分析

The analysis of early pregnancy loss in in vitro fertilization and embryo transfer

目的探讨体外受精-胚胎移植(IVF-ET)后早期妊娠丢失的相关因素。方法回顾性分析2004年1月至2007年8月在本中心行IVF-ET治疗后妊娠的413例的资料,根据妊娠结局分为早期流产组和分娩组,比较两组患者既往妊娠史、支衣原体感染史、治疗方案、受精方式、年龄、不育年限、基础及绒毛膜促性腺激素(hCG)注射日激素水平、内膜厚度、获卵数、胚胎移植(ET)数、ET的优质胚胎数及黄体酮支持等的差异。结果继发不育、既往有异位妊娠或自然流产史及行短方案治疗的患者早期妊娠丢失率高;支衣原体感染及卵胞浆内单精子注射(ICSI)操作对早期妊娠丢失无明显影响;早期流产组的年龄、不育年限、基础卵泡刺激素(FSH)、黄体生成素(LH)水平及FSH/LH均明显高于分娩组(P<0.05);经Logistic回归分析后发现患者既往妊娠史、年龄、FSH/LH及基础LH水平与妊娠早期丢失密切相关。结论引起IVF-ET早期妊娠丢失的原因复杂,可能与患者既往妊娠史、年龄、FSH/LH及基础LH水平等因素相关。

Objective： To analyze the correlation factors of early pregnancy loss among pregnancies produced by in vitro fertilization and embryo transfer （IVF-ET） treatment. Methods： The data of 413 pregnancies following IVF-ET in the Reproductive Medicine Center of First Affiliated Hospital of Wenzhou Medicinal College from January 2004 to August 2007 were analyzed retrospectively. The patients were divided into abortion group and delivery group according to the pregnancy outcome. The abortion history, CT/TT infection, treatment project, ICSI program, age, duration of infertility, endocrine hormone levels on day 3 and hCG administration day, thickness of endometrium on hCG administration day, number of oocytes retrieved, embryos transferred and excellent embryos transferred, and progesterone support were evaluated. Results： The patients who had a history of ectopic pregnancy or spontaneous abortion, or received GnRH-a flare-up protocol had a higher early pregnancy loss rate. CT/TT infection and ICSI program had no significant effects on the early pregnancy loss. There were significantly higher age, duration of infertility, levels of FSH, LH and FSH/LH on day 3 in abortion group than in delivery group （P〈0.05）. After the analysis of Logistic, the abortion history, age and the levels of FSH/LH and LH on day 3 were found to be the important factors related to the early pregnancy loss in IVF-ET. Conclusion： The factors related to early pregnancy loss in IVF-ET are very complicated and there may be something to do with the abortion history, age, the ratio of FSH/LH and the level of LH on day 3.