体质量指数及肥胖对体外受精/卵胞浆内单精子注射周期助孕及结局的影响

Effects of body mass indexes and obesity on procedures and outcomes of IVF/ICSI

目的探讨体质量指数(body mass index,BMI)及肥胖对女性体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)或卵胞浆内单精子注射(intracytoplasmic sperm injection,ICSI)治疗周期助孕及结局的影响。方法回顾性分析成都中医药大学第二附属医院2013~2014年25~35岁行标准长方案IVF-ET或ICSI治疗共631个周期,按照BMI不同分为3组:A组(低体重组47例):BMI<18.5kg/m2;B组(正常体重组440例):18.5 kg/m2≤BMI<24kg/m2;C组(超重组144例):BMI≥24kg/m2;再根据体重的不同将超重组分为两组:体重<70 kg为H1组(104例);体重≥70 kg为H2组(40例)。比较各组基础数据、助孕及妊娠结局。结果 3组间基础卵泡刺激素、基础黄体生成素(basal luteinizing hormone,b LH)值A组>B组>C组,人绒毛膜促性腺激素(human chorionic gonadotropin,h CG)日LH值B组>C组(P<0.05);h CG日雌二醇(estradiol,E2)值A组>B组>C组,A组、B组与C组比较,差异有统计学意义(P<0.05);获卵数A组<B组<C组,A组与C组差异有统计学意义(P<0.05);2PN数A组>B组>C组,B组、C组与A组比较差异有统计学意义(P<0.05);周期取消率A组>B组>C组(P<0.05)。其余资料及超重组亚组各组资料比较差异均无统计学意义(P>0.05)。结论 BMI异常将影响IVF/ICSI助孕治疗结局,低BMI会增加卵巢过度刺激综合征风险,致周期取消率高,BMI过高可影响卵泡发育和使晚卵泡期LH、E2水平过低,使获卵数减少和卵母细胞质量下降,进而影响胚胎发育、植入和妊娠结局。

Objective To explore the effects of body mass index （BMI） and obesity on procedures and outcomes of in vitro fertilization and embryo transfer （IVF -ET）/intraeytoplasmie sperm injection （ICSI）. Methods A retrospective study was conducted on 631 patients ranging from age 25 to 35 with the long protocol IVF/ICSI - ET cycle in The Second Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from January 2013 to December 2014. Patients were divided into three groups according to BMI： group A （underweight group, n =47） ：BMI 〈 18.5kg/m2 ;group B（ normal weight group, n =440） ：18.5g/m2 ≤BMI 〈 24kg/m2 ; group C （ overweight group, n = 144） ： BMI ≥ 24kg/m2. The overweight group was further divided by weight into two groups ： group H1 （weight 〈70kg, n = 104）; group I-I2 （weight ≥70kg , n = 40）. The basic clinic data, treatment and pregnancy outcomes were compared among the groups. Results Comparing the basic FSH and LH , A 〉 B 〉 C （P 〈 0. 05）, the level of LH on the day of hCG injection of group C was significantly lower compared with group B （ P 〈 0.05 ）, and the peak oestradiol on that day in group C was significantly lower compared with the other two groups （P 〈 0. 05）. The number of retrieved oocytes in group C was lower than group A （P 〈 0.05 ）. The diploid number of fertilization （2PN） in group A was significantly higher than the other two groups （ P 〈 0.05 ）. The rate of cancellation resulting of ovarian hyperstimulation syndrome （ OHSS ） among three groups were A 〉 B 〉 C （ P 〈 0. 05 ）. Conclusion BMI abnormalities will affect IVF/ICSI outcomes. Low BMI will increase the risk of OHSS, causing a high rate of cancellation of the cycle. High BMI does not only affect the follicular development, but also lead to lower LH and E2 value in late follicle phase,decreasing the number of retrieved oocytes and affecting quality of oocytes, thus influence the embryo development, implantation and pregnancy outcome.