影响再生育继发不孕妇女体外受精——胚胎移植临床妊娠结局的多因素分析

Factors related to clinical pregnancy outcomes of in vitro fertilization-embryo transfer in women with secondary infertility

目的：比较再生育继发不孕妇女行体外受精—胚胎移植（IVF－ET）后不同临床妊娠结局的影响因素，评估各影响因素对临床妊娠结局的相对重要性，为妇女再生育指导提供科学依据。方法：回顾性分析2012年7月至2014年7月浙江大学医学院附属妇产科医院因再生育继发不孕行IVF－ET的1099例妇女1129个IVF－ET治疗周期的临床、实验室及随访资料。按是否临床妊娠分为两组，通过单因素分析和二元logistic回归分析研究再生育继发不孕妇女行IVF－ET治疗临床妊娠结局的影响因素；比较各年龄阶段不同胚胎移植数的临床妊娠结局；并分析比较促性腺激素释放激素（ GnRH ）激动剂长方案、GnRH激动剂短方案、GnRH拮抗剂方案等3种常用控制性超促排卵（ COH ）方案治疗≥40岁高龄再生育继发不孕妇女的助孕效果。结果：1129个治疗周期中临床妊娠376例次（33．30％），未临床妊娠753例次（66．70％），这两组女方年龄、女方体质量指数、基础卵泡刺激素、窦卵泡数、移植胚胎数和男方年龄差异有统计学意义（均P＜0．05）。二元logistic回归分析发现年龄（ OR ＝0．900，95％CI：0．873-0．928， P ＜0．001）、移植胚胎数（ OR＝2．248，95％CI：1．906-2．652， P＜0．001）是再生育继发不孕妇女行IVF－ET治疗临床妊娠是否成功的独立影响因素。30-40岁移植双胚胎与＜30岁移植多胚胎妇女的临床妊娠率差异无统计学意义（ P＞0．05）。年龄≥40岁再生育继发不孕妇女应用GnRH激动剂长方案、GnRH激动剂短方案和GnRH拮抗剂方案三组妇女临床妊娠率差异无统计学意义（ P＞0．05）。结论：年龄和胚胎移植数是预测再生育继发不孕妇女行IVF－ET治疗临床妊娠结局的独立影响因素。30-40岁妇女建议移植胚胎数不超过2个。年龄≥40岁再生育继发不孕妇女的临床妊娠率显著降低，应用GnRH激动剂长方案、GnRH激动剂短方案、GnRH拮抗剂方案对其临床妊娠率无明显影响。

Objective： To investigate the factors related to clinical pregnancy outcomes of in vitor fertilization-embryo transfer （ IVF-ET ）in women with secondary infertility .Methods：The clinical , laboratory and follow-up data of 1129 cycles in 1099 patients with secondary infertility undergoing IVF-ET in Women’s Hospital, Zhejiang University School of Medicine between July 2012 to July 2014 were retrospectively reviewed.The factors related to pregnancy outcomes were analyzed by univariate and logistic regression methods .The clinical pregnancy rates in women with different age and different number of embryos transferred were compared .The clinical outcomes of stimulation with gonadotropin releasing hormone （ GnRH ） agonist long protocol , GnRH agonist short protocol and GnRH antagonist protocol were evaluated in secondary infertile patients aged≥40 years.Results： Among 1129 cycles, 376 cases（ 333.0 %） had clinical pregnancy and 753 cases（66.70%）had no clinical pregnancy.There were significant differences in age , body mass index , basal follicle-stimulating hormone level , antral follicle number , paternal age and number of embryos transferred between pregnancy and no pregnancy groups（P〈0.05）;while only maternal age（OR=0.900, 95%CI：0 .873 -0 .928 , P 〈0 .001 ）and the number of embryos transferred （O R =2.248,95%CI：1.906-2.652,P〈0.001）were the independent factors affecting the clinical pregnancy outcome of IVF-ET.There was no significant difference in clinical pregnancy rate between women aged 30 -40 years with two embryos transferred and those aged〈30 years with two or three embryos transferred （ P〉0.05 ） .There were no significances in clinical pregnancy rate among women aged ≥40 years using GnRH agonist long protocol , GnRH agonist short protocol and GnRH antagonist protocol for stimulation（P〉0.05）.Conclusion： Maternal age and number of embryos transferred have independent effect on IVF-ET clinical pregnancy outcome of secondary infertile women.We suggest that no more than two embryos should be transferred for women in their thirties to minimize the risk of multiple pregnancy while still having an acceptable pregnancy rate .The pregnancy rate of patients over 40 years decreases significantly , and there is no difference in pregnancy rate by using GnRH agonist long protocol ,GnRH agonist short protocol or GnRH antagonist protocol .