不同MHTFR基因型的IVF/ICSI患者妊娠结局的比较

he comparison of the IVF/ICSI Patients' Outcome with the C677T Mutation of the 5,10-Methylenetetrahydrofolate Reductase

目的IVF/ICSI患者三种MTHFR基因C677T突变的妊娠结局的比较。方法自2016年1月-2016年12月就诊于本院生殖助孕中心行体外受精助孕治疗并随访结束的患者共846例,按照MTHFR基因的C677T突变分成三组:A组:CC型(=207例);B组:CT型(=378例);C组:TT型(=261例)。分别记录三组患者的年龄、不孕年限、基础E2水平、基础FSH水平、血清肌酐(Hcy)水平,AMH水平,对以上基础信息进行比较。记录患者在超促排过程中的外源性药物总量(即Gn总量)、HCG日的雌二醇(E2)水平、促排天数、获卵个数、受精情况、优质胚胎个数,计算受精率、优质胚胎率,对促排的相关结果进行比较。行胚胎移植的患者至随访结束,对生化妊娠结局、临床妊娠结局、活产、流产、宫外孕进行记录,计算生化妊娠率、临床妊娠率、活产率、流产率、异位妊娠率,并进行三组间的比较。结果A、B、C三组基因型患者的年龄、不孕年限、基础E2水平、基础FSH水平、AMH均未见明显差异,促排的Gn总量、HCG日的E2水平、促排天数、获卵个数、受精率、优质胚胎率均无统计学差异,C组患者血清中的Hcy值高于A组与B组,并具有统计学差异。B组患者的生化妊娠率、临床妊娠率、活产率均高于A组及C组,但无统计学意义。而C组患者的流产率及异位妊娠率均高于A组及B组,但统计学无差异。结论MTHFR基因的C677T突变对IVF/ICSI患者的妊娠结局无具有统计学差异的影响。

Objective To compare the pregnant outcome after the C677T between three MTHFR genotypes were mutated in IVF/ICSIpatients. Methods 846 patients, who were treated in our center from January to December in 2016, were separated into 3 groups according to C677T mutation of the MTHFR. Group A was CC type（ =207）, group B was CT type（ =378）, and group C was TT type（ =261）. All patients were recorded about the ages,infertility age, the basic estradiol level（E2）,the basic FSH level, the homocysteine（Hcy） level in serum and the AMH level. All data were compared among all of them. At the same time, the total Gn doses, the E2 level at the HCG day, the ovulation days, the number of oocytes, the fertility rate, the high-quality embryos rate were determined and compared. Furthermore, after follow-up, the 14 days pregnancy after embryo transplantation, the clinical pregnancy outcome, the live-birth,the abortion, the ectopic pregnancy were recorded and the biochemical pregnancy rate, the clinical pregnancy rate, the live-birth rate, the abortion rate, the ectopic pregnancy rate were calculated and compared. Results There were no statistical differences in ages, infertility age, the basic E2 level, the basic FSH level, the AMH level（ P〉0.05）among three groups. The total Gn doses, the E2 level of the HCG day, the ovulation days, the number of oocytes, the fertilization rate, the high-quality embryos rate were no statistical differences, too（P〉0.05）.The Hcy level of group C was higher than that in group A and group B, which had statistical significance（P〈0.05）. Biochemical pregnancy rate, clinical pregnancy rate, live-birth rate in group B were higher than those in group A and group C. But none of these data had statistical significance（P〉0.05）. Abortion rate, the ectopic pregnancy rate in group C were higher than those in group A and group C, but none of these data had statistical significance（P〉0.05）. Conclusion The C677T mutation of the MTHFR had no statistical effect on the pregnant outcomes of IVF/ICSI patients.