体外受精-胚胎移植中卵巢反应不良患者妊娠成功率的相关因素分析

Factors associated with successful pregnancy in patients with poor ovarian response during in vitro fertilization and embryo transfer

目的探讨体外受精-胚胎移植中卵巢反应不良患者妊娠成功率的影响因素。方法回顾性分析IVF-ET/IVF-ICSI治疗的1 376个临床卵巢反应不良周期的妊娠情况进行分析,采用回顾性病例对照研究的方法,对妊娠组与非妊娠组的相关因素进行分析。结果两组年龄、不孕年限、不孕原因、是否有手术史,周期数、基础性激素水平、促排卵方案、Gn种类、hCG日激素水平、获卵数、成熟卵子数、hCG日内膜厚度及形态、受精率、可移植胚胎数、优质胚胎数等因素比较,差异有统计学意义。用药方案、女方年龄、可利用胚胎、优质胚胎进入多重线性回归模型。结论影响卵巢反应不良妊娠结局最重要的因素是年龄,对于年龄小于35岁的反应不良患者,可获取卵子数目的减少并不等同于卵子质量的下降,在获得可供移植的胚胎后仍可获得不错的妊娠率。各种超排卵方案中,长方案仍然是妊娠率较高的一种方法,对于具备一定程度卵巢储备的患者,仍然不要放弃传统长方案(包括长效长方案和短效长方案)的使用。

Objective To identify factors affecting pregnancy rate in patients with poor ovarian response during in vitro fertilization and embryo transfer （IVF-ET/IVF-[CSI） treatment. Methods A total of 1 376 cycles of IVF-ET/IVF- ICSI were analyzed retrospectively by comparing pregnant and non-pregnant women suffering from ovarian poor response. Results There were statistical differences between the two groups with regard to age, years expiring infertility, causes of infertility, surgery history, cycle number, basal sex hormone level, stimulating ovulation protocol, Gn type, hormone level on the day of hCG injection, numbers of ooeytes retrieved, numbers of mature ooeytes, endothelium thickness on the hCG injection, fertilization rate, embryo cleavage rate, number of embryos transfe^Ted, and number of good quality embryos. Multivariate logistic regression showed that age, stimulating ovulation protocol, number of good quality embryos, and embryo morphology were associated with pregnancy. Conclusion Age is the most important factor that affects the pregnant outcome of ovarian poor response. For patients younger than 35 years, the reduction of the number of oocytes retrieved doesn＇t mean the reduction of the quality of oocytes. Rather, pregnancy could be achieved after embryos transfer. Among the superovulation induction protocols for patients with certain ovarian reserve, long protocol （ including long-lasting protocol and short-long protocol） may be a way to achieve a higher pregnancy rate.