体质量指数对多囊卵巢综合征患者移植优质胚胎后早期妊娠丢失的影响

Influence of Body Mass Index on Risk of Early Pregnancy Loss after High-Quality Embryo Transfer in PCOS Patients

目的:探讨多囊卵巢综合征(PCOS)患者体质量指数(BMI)对体外受精-胚胎移植(IVFET)助孕后早期妊娠丢失(包括生化丢失和早期流产)的影响。方法:回顾性分析2011年1月至2013年9月诊断为PCOS并接受体外受精-胚胎移植(IVF-ET)助孕的患者,仅入选有优质胚胎可供移植的共453个周期(453例)的临床资料,除外低体质量组(BMI<18.5 kg/m^2)的13个周期后,根据BMI分为3组:正常组(18.5 kg/m^2≤BMI<24.0 kg/m^2)229个周期,超重组(24.0 kg/m^2≤BMI<28.0kg/m^2)136个周期和肥胖组(BMI≥28.0 kg/m^2)75个周期。对3组的基础、代谢、早期的妊娠丢失情况进行比较,并对早期妊娠丢失的相关因素行多元Logistic回归分析。结果:1正常组的LH值(11.45±5.95 U/L)高于肥胖组(8.64±4.34 U/L);空腹血糖(FBG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)指标在正常组、超重组和肥胖组间呈上升趋势,3组间比较差异均有统计学意义(P<0.05)。2接受优质胚胎移植后,肥胖组早期妊娠丢失率、生化妊娠丢失率明显高于正常组和超重组(P<0.05),而种植率明显低于正常组(P<0.05)。3Logistic回归分析显示:PCOS患者移植优质胚胎后,早期妊娠丢失与年龄、基础雄激素水平、BMI呈正相关(P<0.05),与移植日内膜厚度呈负相关(P<0.05)。结论:BMI增高显著伴随着基础LH水平和胰岛素抵抗指标的异常,增高的BMI可能是导致胚胎质量良好的PCOS患者早期妊娠丢失(尤其是生化妊娠丢失)的独立因素之一。

Objective： To observe the correlation between body mass index（ BMI） and early pregnancy loss（ including biochemical pregnancy loss and early abortion） after high-quality embryo transplantation in PCOS patients. M ethods： A retrospective analysis was implemented on the patients diagnosed with PCOS and accepted the in vitro fertilization and embryo transplantation（ IVF-ET） in reproductive center in Henan province people＇ s hospital from January 2011 to September 2013. 453 women were transplanted with high-quality embryo,and eventually 440 patients,excluding the women who had BMI≤18. 5 kg / m^2（ low-weight group）,were classified into three groups based on their BMI at the time of having ET,229 had BMI（ 18. 5- 24. 0 kg / m^2）（ normal-weight group）,136 had BMI（ 24. 0- 28. 0 kg / m^2）（ over-weight group） and 75 had BMI≥28. 0 kg/m^2（ obese group）.Basic information,metabolic condition,pregnancy loss and other gestation information were analyzed between each group. Then Logistic regression analysis was employed on relevant factors on early pregnancy loss of PCOS patients. Results： 1 LH values of normal BMI group（ 11. 45 ± 5. 95 U / L） was significantly higher than high BMI group（ 8. 64 ± 4. 34 U / L）,and index of FBG,FINS,HOMA-IR significantly rose with the increase of BMI between every two groups（ P〈 0. 05）. 2After transplanted with high-quality embryo,the obese group had significantly higher early pregnancy loss rate and biochemical pregnancy loss rate and lower implantation rate than normal-weight group（ P〈 0. 05）. 3Logistic regression analysis showed that for patients with PCOS accepted high quality embryos transplantation,basic androgen level,age and BMI were positively related to early pregnancy loss,while endometrial thickness before progesterone supplementation is negatively correlated with early pregnancy loss. Conclusions： BMI increases along with significantly abnormity of basic LH level and insulin resistance. Increased BMI significantly increases early pregnancy loss rate,especially biochemical pregnancy loss rate,and may be one of independent influencing factors to early pregnancy loss of PCOS patients with high-quality embryos transplantation.