卵巢储备功能下降患者IVF-ET妊娠早期流产相关因素分析

The analysis of early pregnancy loss in women with diminished ovarian reserve after in vitro fertilization-embryo transfer

目的回顾性分析卵巢储备功能下降(diminished ovarian reserve,DOR)患者行体外受精/卵母细胞浆内单精子注射-胚胎移植(IVF/ICSI-ET)助孕妊娠后发生早期自然流产的危险因素。方法选择2015年1月至2016年9月于首都医科大学附属北京妇产医院生殖中心因输卵管因素和/或男方因素进行IVF/ICSI-ET助孕的DOR患者共229例,分为自然流产组和分娩组,对比两组患者的年龄、体重指数(body mass index,BMI)、基础内分泌水平、窦卵泡数(antral follicle counts,AFC)及IVF结局,分析DOR患者早期自然流产发生的高危因素。结果 DOR流产组的年龄、基础卵泡刺激素(basal follicle stimulating hormone,b FSH)水平显著高于分娩组(P<0.05);经Logistic回归分析发现年龄和b FSH与自然流产的发生密切相关;两组BMI、AFC、促性腺激素(gonadotropin,Gn)总量和天数、h CG日激素水平和内膜厚度、获卵数、受精率及移植胚胎数等差异均无统计学意义(P>0.05)。结论年龄、b FSH是DOR患者在IVF助孕后发生早期自然流产的危险因素,而BMI、AFC及IVF结局与DOR患者早期自然流产的关系尚需扩大样本进一步研究。

Objective：To retrospectively analyze the risk factors of pregnancy loss in patients with diminished ovarian reserve（DOR）after in vitro fertilization/intracytoplasmic sperm injection-embryo transfer（IVF/ICSI-ET）. Methods： 229 DOR women undergoing IVF/ICSI-ET therapy due to tubal and/or male factors from January 2015 to September 2016 were analyzed. All patients were divided into two groups,including the miscarried group and the delivered group. Age,body mass index（BMI）,the basal hormone levels and IVF outcomes were compared between the two groups in order to explore the risk factors associated with early pregnancy loss among DOR patients. Results：In miscarried group,the age and basal follicle stimulating hormone（b FSH）are significantly higher compared with the delivered group（P〈0.05）. Multiple factors Logistic regression analysis showed that age and b FSH were in correlation with pregnancy loss in DOR women. There was no significant difference in BMI,antral follicle count（AFC）,the total doses and duration of gonadotropin（Gn）,h CG day hormone levels and endometrial thickness,retrieved oocytes,fertilization rate and the number of embryo transfer（P〉0.05）. Conclusion：Age and b FSH are risk factors of pregnancy loss in patients with DOR after IVF-ET therapy. The relationship between BMI,AFC,IVF outcome and DOR pregnancy loss remains further study.