多囊卵巢综合征患者体外受精/卵胞质内单精子注射-胚胎移植后自然流产相关高危因素的多元回归分析

Logistic regression analysis of risk factors associated with spontaneous abortion after in vitro fertilization/intracytoplasmic sperm injection-embryo transfer in polycystic ovary syndrome patients

目的通过了解多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者行体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)助孕后自然流产的发生率及其相关危险因素,探讨PCOS患者IVF-ET后流产的相关危险因素,以为临床改善PCOS患者助孕结局提供理论依据。方法回顾性分析因输卵管因素和/或男方因素行IVF/ICSI-ET助孕的PCOS患者共2231例(PCOS组),对照组为条件匹配的因输卵管因素进行助孕治疗的非PCOS患者共2231例,分析其自然流产率和染色体核型异常率。将PCOS组分为自然流产组和持续妊娠组,利用多元回归分析方法探索PCOS自然流产发生的高危因素。结果 PCOS组的自然流产率(24.15%)较对照组高(12.75%),差异有显著统计学意义(P<0.001)。在流产的患者中,PCOS组的染色体核型异常率(36.05%,31/86)较对照组低(55.56%,50/90),差异有统计学意义(P=0.009)。在PCOS患者中,自然流产组的年龄、体质量指数(body mass index,BMI)、HOMA指数水平显著高于持续妊娠组(P<0.05);经Logistic回归显示,年龄、HOMA指数及BMI与自然流产的发生密切相关;周期类型、移植胚胎质量、移植胚胎数、空腹血糖、空腹胰岛素及基础性激素等组间均无统计学差异(P>0.05)。结论与非PCOS患者相比,PCOS患者的流产率高。染色体核型异常不是PCOS患者高流产率的主要因素。年龄、BMI及HOMA指数是PCOS患者在IVF/ICSI-ET助孕后发生自然流产的危险因素。

Objective To analyze spontaneous abortion rate and its associated risk factors in patients with polycystic ovary syndrome（PCOS） after in vitro fertilization/intracytoplasmic sperm injection-embryo transfer（IVF/ICSI-ET）. Methods This was a retrospective cohort study of patients undergoing IVF/ICSI treatment. A total of 2231 patients with PCOS were included. For comparison, we enrolled 2231 patients with tubular factors as control group. Spontaneous abortion rate and chromosomal abnormality rate were compared between the two groups.Furthermore, clinical data were compared between patients of spontaneous abortion and those of ongoing-pregnancy using univariate and multivariate analysis for risk factors of spontaneous abortion in PCOS patients. Results Patients in PCOS group had significantly higher spontaneous abortion rate（24.15%） than control group（12.75%, P〈0.001）.Chromosomal abnormality rate was significantly lower in PCOS group（36.05%, 31/86） than in control group（55.56%,50/90, P=0.009）. In PCOS group, patients of spontaneous abortion had older age, higher body mass index（BMI） and homeostasis model assessment for insulin resistance（HOMA-IR） than those of ongoing pregnancy. All the differences reached statistically significant. The further Logistic regression analysis confirmed that the age, BMI and HOMA-IR were risk factors of spontaneous abortion in PCOS patients. There were no significant differences in the type of cycles, the quality of embryos transferred, the number of embryos transferred, fasting blood glucose,fasting insulin, ect. Conclusion Compared with non-PCOS patients, PCOS patients had higher rate of miscarriage,but chromosomal abnormality was not a major factor for the high rate of miscarriage in PCOS patients. Age, BMI and HOMA-IR were risk factors for spontaneous abortion after IVF/ICSI-ET in PCOS patients.