辅助生殖技术中影响异位妊娠发生的相关危险因素分析

Analysis of Related Risk Factors Influencing the Incidence of Ectopic Pregnancy in ART

目的:探讨辅助生殖技术(assisted reproductive technology,ART)后发生异位妊娠的危险因素。方法:收集2014年1月至2016年1月在本院生殖中心行ART治疗并获得临床妊娠的8548例患者的临床资料,包括女方年龄、体质量指数(BMI)、不孕原因、异位妊娠史、冻融胚胎移植内膜准备方式、胚胎移植类型、数目和期别。采用单因素及多因素Logistic回归分析不同因素对于ART后异位妊娠发生的影响。结果:8548例患者中,异位妊娠196例,异位妊娠率为2.29%。单因素分析结果显示,异位妊娠组盆腔输卵管因素、非男方因素、既往异位妊娠史、新鲜胚胎和D3胚胎移植比例均高于非异位妊娠组(P<0.05)。将以上因素纳入多因素Logistic回归分析,结果显示,盆腔输卵管因素(OR=1.524,95%CI 1.100~2.111,P=0.011)和D3胚胎移植是行ART后异位妊娠发生的独立危险因素。且移植D6胚胎要比移植D5胚胎发生异位妊娠的风险低。进一步对盆腔输卵管因素进行分层分析,表明移植D5或D6胚胎异位妊娠发生率显著降低(P<0.01)。结论:盆腔输卵管因素以及D3胚胎移植可导致ART后异位妊娠发生增加。囊胚移植,尤其是D6囊胚移植有利于降低异位妊娠发生的风险。

Objective：To study the risk factors of ectopic pregnancy after receiving assisted reproductive tech- nology（ART） treatment. Methods：The clinical data of 8548 patients with clinical pregnancies by ART treatment were collected from Jan. 2014 to Jan. 2016 in the Third Affiliated Hospital of Guangzhou Medical University,inclu- ding maternal age,BMI, causes for infertility, EP history, methods for endometrium preparation in frozen embryo transfer（FET） cycles,the type of embryo transferred,the stage and number of embryo transferred, The potential risk factors of ectopic pregnancy（EP） were investigated by univariate analysis and multivariate logistic regression analysis. Results：The total cohort included 8548 patients, and 196 patients of them were ectopic pregnancies. The EP rate was 2. 29%. The univariate analysis showed that the proportions of pelvic/tubal factor,non-male fac- tor, EP history,fresh embryo transfer and D3 embryo transfer were higher in EP group than those in non-EP group （P 〈0. 05）. Multivariate logistic regression analysis showed that pelvic/tubal factor（ OR = 1. 524,95%CI 1. 100 -2. 111, P=0. 011 ） and DC3 embryo transfer were independent risk factors of EP. Moreover,the risk of ectopic pregnancy on D6 embryo transfer was lower than that of D5 embryo transfer, Stratified chi-square analysis on the pelvic/tubal factor fur- ther confirmed that D5 or D6 embryo transfer significantly reduced EP occurrence（ P 〈0. 01 ）. Conclusions ：The pelvic/ tubal factor and D3 embryo transfer increased the EP rate. The blastocyst transfer, particularly D6 blastocyst transfer was associated with a reduced risk of EP.