辅助生殖技术助孕后单胎妊娠早期流产的相关因素分析

Associated factors of early abortion among singleton pregnancies after assisted reproductive technology

目的 探讨辅助生殖技术（assisted reproductive technology，ART）助孕后单胎妊娠发生早期自然流产的相关因素。方法 对2003年1月1日至2008年8月31日在本院生殖中心行常规体外受精／卵母细胞浆内单精子注射的新鲜胚胎移植周期治疗后的1636例单胎妊娠病例进行分析，除外失访、子宫畸形、赠卵、晚期流产及资料不齐全者后，分为早期流产组（n=196）和活产分娩组（n=1195），分析早期流产的相关因素。同时，比较新鲜胚胎移植周期和冷冻胚胎复苏移植周期（n=386）的流产率。结果 多因素Logistic回归分析早期自然流产的危险因素是孕妇年龄（OR=1．143，95％CI：1．096～1．196）、多囊卵巢综合征因素不孕（OR=4．309，95％CI：2．564～7．243），保护因素是移植胚胎的平均评分（OR=0．808，95％CI：0．717-0．912）、人绒毛膜促性腺激素（human chorionic gonadotropin，hCG）注射日子宫内膜三线型（OR=0．431，95％CI：0．243～0．764）。早期流产组和活产分娩组孕妇的年龄[（32．22±4．10）岁和（30．28±3．66）岁]、不孕年限[（5．90±4．26）年和（5．20±3．32）年]、基础卵泡刺激素水平[（6．35±2．30）mIU／ml和（5．95±2．12）mIU／ml]、移植胚胎数[（2．31±0．51）个和（2．18±0．49）个]、hCG注射日雌二醇水平[（2467．1±1588．8）pg／ml和（2934．5±1785．2）pg／m1]、胚胎平均评分（7．03±1．35和7．74±1．25）比较，差异均有统计学意义（P〈0．05），冷冻胚胎复苏移植周期流产率高于新鲜周期[17．36％（67／386）和13．02％（213／1636），X2=4．296，P=0．023]。结论 年龄大、不孕年限长、基础卵泡刺激素高、多囊卵巢综合征因素不孕、移植胚胎的平均评分低、hCG注射日子宫内膜非三线型的妇女ART妊娠后易发生早期流产。冷冻胚胎复苏移植周期的早期自然流产率高于新鲜胚胎移植周期。

Objective To investigate the relative risk tactors tot early abortion among singleton pregnancies after assisted reproductive technology （ART） treatment. Methods A retrospective analysis was performed on 1636 singleton pregnancies, including 196 early abortion cases and 1195 pregnancies with live birth after exclusion of those lost cases during follow-up, or complicated with uterine deformity, or oocyte receptor, or late abortion, or incomplete medical record, following in vitro fertilization（IVF）/ intracytoplasmic sperm injection （ICSI） treatment and the risk factors of early abortion were investigated. The early abortion rate was also compared between fresh IVF/ICSI group and frozen embryo transfer （FET） group （n=386）. Results Multivariate Logistic regression analysis indicated that elder women （OR=1. 143,95%CI： 1. 096-1.196） and patients with polycystic ovarian syndrome （OR=4.309,95%CI：2. 564-7.243） were risk factors of spontaneous early abortion, and high mean score of transferred embryos （MSTE） （OR=0.808, 95%CI： 0.717- 0.912） and endometrial triple-lined pattern on the day of human chorionic gonadotropin （hCG） administration （OR=0.431, 95% CI： 0.243-0.764）were protective factors. Significant difference were found in the maternal age [（32.22±4.10） yrs vs （30.28±3.66） yrs], the duration of infertility [（5.90±4.26） yrs vs （5.20±3.32） yrs], basal serum follicle-stimulating hormone （FSH） level [（6.35±2.30） mIU/ml vs （5.95±2.12） mIU/ml], number of transferred embryos （2.31±0.51） vs （2. 18±0.49）, serum estradiol level on the day of hCG administration [（2467.1±1588.8） pg/ml vs （2934.5±1785.2） pg/ml] and MSTE （7.03±1.35 vs 7.74±1.25） between the abortion group and livebirth group （all P〈0.05）. The spontaneous abortion rate was higher in the FET group than in the fresh embryo transfer group [17.36±（67/386） vs 13.02±（213/1636）, X2=4.296, P=0.023]. Conclusions Women at elder age, or with long duration of infertility, high basal FSH level, polycystie ovarian syndrome, low MSTE, non-triple-lined pattern of endometrium on the day of hCG administration are at risk of spontaneous early abortion in pregnancies after ART. The rate of spontaneous abortion is higher in FET group than in fresh IVF/ICSI group.