体外受精-胚胎移植重复周期的妊娠结果

Pregnancy outcomes of repeated cycles of in vitro fertilization and embryo transfer

目的:分析体外受精-胚胎移植(IVF-ET)失败后进行重复治疗周期的妊娠结果。方法:回顾性分析了2006～2008年我院生殖中心进行的702个重复IVF-ET周期(503例),其中先前失败周期在外院和在本院进行的分别有191个(A组)和511个周期(B组)。分析其妊娠结果与重复周期的次数和患者年龄的关系。结果:A组先前失败周期为1次、2次和2次以上在我中心行重复IVF-ET的临床妊娠率无明显差异(56.56%vs66.67%vs61.54%);2次以上失败后的重复周期获卵数显著减少(4.86±2.96vs8.51±4.60vs8.48±3.32),其基础促卵泡生成素(FSH)水平(mIU/ml)显著增高(11.58±11.40vs7.31±3.66vs6.83±2.35)。B组先前失败周期为1次、2次和2次以上的重复周期与本中心首次IVF周期的临床结果比较显示:先前1次失败周期的临床妊娠率、获卵数、移植胚胎数和流产率与本中心首次IVF周期无显著差异;先前2次失败周期的注射绒毛膜促性腺激素(hCG)日E2水平(pg/ml)显著降低(2396.87±1602.02vs4061.17±2255.63),获卵数显著减少(6.66±4.58vs9.59±4.30);先前2次以上失败周期的临床妊娠率、获卵数、内膜厚度和基础FSH水平均显著降低。B组中女方年龄<38周岁的先前失败<3次的患者,其重复周期妊娠率和种植率无明显降低,但先前失败3次以上者的妊娠率和种植率显著降低;女方年龄>38周岁,1～4次的妊娠率、种植率均明显降低。结论:IVF-ET重复周期的妊娠结果与周期次数无相关性,可能与不同中心对患者的治疗有直接相关。同一中心IVF-ET3次以内,妊娠率与周期次数无明显关系,4次以上妊娠率明显下降;年龄可以影响重复周期的结果,超过38岁,妊娠率、种植率下降。

Objective：To analyze the pregnancy outcomes of repeated IVF-ET cycles.Methods：We retrospectively analyzed 702 repeated IVF-ET cycles（503 cases）performed in our center from 2006 to 2008,among which 191 cycles（Group A）had failed previously in other hospitals and 511（Group B）in ours,focusing on the relationship of pregnancy outcomes with the number of repeated IVF-ET cycles and the age of the patients.Results：In Group A,there were no significant differences in pregnancy rates among the patients with 1,2 or 2 previously failed cycles（56.56% vs 66.67% vs 61.54%）,while the numbers of oocytes obtained were significantly decreased（8.51 ± 4.60 vs 8.48 ± 3.32 vs 4.86 ± 2.96）and the serum levels of follicle stimulating hormone（FSH）remarkably increased（[7.31 ± 3.66] mIU/mL vs [6.83 ± 2.35] mIU/mL vs [11.58 ± 11.40] mIU/mL）in those with 2 previous failures.In Group B,the results of the first IVF-ET cycle in our center showed that the number of oocytes obtained and the E2 level on the day of hCG injection were markedly decreased in the patients with 2 previously failed cycles（6.66 ± 4.58 vs 9.59 ± 4.30 and 2 396.87 ± 1 602.02 vs 4 061.17 ± 2 255.63）,and so were the pregnancy rate,oocyte number,intimal thickness and essential FSH level in those with 2 previous failures,but no significant differences were found in the rate of pregnancy,number of oocytes obtained,number of embryos transplanted and rate of abortions in those with 1 previous failure.The pregnancy and implantation rates of the repeated IVF-ET cycles were significantly reduced in the female patients aged 38 years and with 3 previously failed cycles,as well as in those aged 38 years and with 1-4 previous failures,but not in those aged 38 years and with 3 previous failures in Group B.Conclusion：The pregnancy outcome of repeated IVF-ET cycles was not correlated with the number of the cycles,but maybe directly with different protocols in different reproductive centers.The rate of pregnancy was obviously decreased in patients that underwent over 4 repeated IVF-ET cycles,but had no obvious correlation with the number of cycles in those that received 1-3 cycles in the same reproductive center.The age of the patient influences the results of repeated IVF-ET cycles,and both pregnancy and implantation rates may decrease in those aged 38 years.