获卵数目对辅助生殖结局的影响分析

Analysis on the effect of number of retrieved oocytes on outcome of assisted reproduction

目的探讨获卵数目和辅助生殖结局的关系,为临床研究提供参考依据。方法回顾性分析2015年3月-2017年3月在该院接受辅助生殖技术/卵泡浆内单精子显微注射(IVF/ICSI-ET)的1 671例患者的临床结局。按患者获卵总数由低到高分为甲组(获卵数≤5,319例)、乙组(5<获卵数≤10,536例)、丙组(10<获卵数≤15,442例)和丁组(获卵数>15,374例),收集患者年龄、孕次、活产情况等数据。计量资料和计数资料分别用方差分析和χ~2检验进行分析,多因素Logistic回归用于校正混杂因素,并分析获卵数目和临床活产率的关系。结果 4组间年龄、孕次、基础激素水平、Gn启动情况比较,差异均有统计学意义(均P<0.05);4组临床妊娠率、活产率比较,差异均有统计学意义(均P<0.05);且丙组临床妊娠率(43.4%)和活产率(36.0%)均最高,而甲组临床妊娠率(34.2%)最低,丁组活产率(26.7%)最低,但流产率、异位妊娠率等差异均无统计学意义(均P>0.05)。通过多因素Logistic回归校正混杂因素后,发现相较于丙组,丁组临床活产率显著下降,其OR值为0.426(P<0.05)。结论获卵数在11~15个之间时,临床妊娠率、活产率最佳,而获卵数≤5个时对临床妊娠率不利,而>15个时则影响临床活产率。

Objective To explore the relationship between number of retrieved oocytes and outcome of assisted reproduction,provide a reference basis for clinical studies. Methods The clinical outcomes of 1 671 patients undergoing in vitro fertilization/intracytoplasmic sperm injection and embryo transfer（ IVF/ICSI-ET） in Chengdu Women＇s and Children＇s Central Hospital from March 2015 and March 2017 were retrospectively reviewed. According to the total number of retrieved oocytes,the patients were divided into group A（ ≤5,319 patients）,group B（ 5number≤10,536 patients）,group C（ 10number≤15,442 patients）,and group D（ 15,374 patients）. The general information（ age,gravidity,live birth,and so on） was collected. Measurement data and enumeration data were analyzed by variance analysis and Chi-square test,respectively. The confounding factors were adjusted by multivariate logistic regression model,the relationship between number of retrieved oocytes and clinical live birth rate was analyzed. Results There were statistically significant differences in age,gravidity,basic hormone level,initiation of gonadotropin（ Gn）,clinical pregnancy rate,and live birth rate among the four groups（ P〈0. 05）.The clinical pregnancy rate and live birth rate in group C were 43. 4% and 36. 0%,respectively,which were the highest; the clinical pregnancy rate in group A was 34. 2%,which was the lowest; the live birth rate in group D was 26. 7%,which was the lowest. There was no statistically significant difference in abortion rate and ectopic pregnancy rate among the four groups（ P〉0. 05）. After adjusting confounding factors,multivariate logistic regression analysis showed that the clinical live birth rate in group D decreased significantly compared with group C（ OR = 0. 426,P〈0. 05）. Conclusion When the number of retrieved oocytes is between 11 and 15,the clinical pregnancy rate and live birth rate are the best; when the number of retrieved oocytes is no more than 5,clinical pregnancy rate decreases,but the number of retrieved oocytes15 affects clinical live birth rate.