原发不孕与继发不孕症的辅助生殖助孕治疗结局分析

Analysis of the Outcome of Assisted Reproductive Therapy for Primary Infertility and Secondary Infertility

目的探讨原发不孕及继发不孕症夫妇体外受精-胚胎移植(IVF-ET)助孕治疗的胚胎发育及临床结局差异,为不孕症患者在IVF治疗中提供科学指导。方法共纳入该中心2014年8月—2015年8月475例接受IVF-ET的周期进行回顾性分析,男方因特发性少精子症或极度弱精症的周期不包括在该研究中。按照既往妊娠史将纳入病例分为原发不孕组(215例)及继发不孕组(260例)。根据女方不孕类型、不孕年限及精液是否正常,比较两组胚胎发育及临床结局差异。结果 (1)原发不孕组平均年龄小于继发不孕组[(30.56±4.26)岁vs (32.1±5.00)岁,t=-3.77,P<0.05)],但其不孕年限更长[(4.86±3.52)年vs (4.0±3.31)年,t=6.03,P<0.05]、BMI指数较低[(21.20±3.04)kg/m^2比(21.85±2.90)kg/m2,t=-2.39,P<0.05)]。原发不孕组2PN受精率比继发不孕低(68.59%vs 74.65%,χ~2=20.24,P<0.05),但其他临床结局与继发不孕组差异无统计学意义(P>0.05)。2.不孕年限≥5年与<5年中,原发不孕组2PN受精率分别为58.68%、64.67%(χ~2=4.40,P<0.05),继发不孕组2PN受精率分别为70.98%、75.90%(χ~2=5.77,P<0.05),其余指标均差异无统计学意义(P>0.05)。(3)两组中男方单纯弱精与精液正常的所有指标均差异无统计学意义(P>0.05)。结论 (1)原发不孕患者较继发不孕患者年轻,但不孕年限更长,IVF正常受精率较低,但两组的临床结局没有统计学差异。(2)随着不孕年限的延长,不受精或者异常受精的风险增大,正常受精的概率降低。(3)在常规IVF中,男方单纯弱精可获得与正常精液同样的临床结局。

Objective To investigate the differences in embryonic development and clinical outcomes between infertility and infertility couples in vitro fertilization-embryo transfer (IVF-ET), and provide scientific guidance for infertility patients in IVF treatment. Methods A total of 475 patients who underwent IVF-ET from August 2014 to August 2015 were retrospectively analyzed. The period of men with idiopathic oligozoospermia or extreme asperity was not included in the study. According to the previous pregnancy history, the included cases were divided into primary infertility group (215 cases) and secondary infertility group (260 cases). According to the type of infertility, infertility and semen, the differences in embryonic development and clinical outcomes between the two groups were compared. Results 1.The average age of the primary infertility group was smaller than that of the secondary infertility group [(30.56±4.26)years old vs (32.1±5.00)years old, t=-3.77, P<0.05), but the infertility period was longer[(4.86±3.52)yers old vs.(4.0±3.31)yers old,(t=6.03, P<0.05), and the BMI index was lower (21.20±3.04)kg/m^2 vs (21.85±2.90)kg/m^2, t=-2.39, P<0.05)]. The 2PN fertilization rate in the primary infertility group was lower than that in the secondary infertility (68.59% vs 74.65%,χ^2=20.24, P<0.05), but there was no statistical difference between the other clinical outcomes and the secondary infertility group(P>0.05). 2. Infertility years ≥ 5 years and <5 years, the 2PN fertilization rate of the primary infertility group was 58.68%, 64.67%(χ^2=4.40, P<0.05), and the secondary infertility group 2PN fertilization rate was 70.98%, 75.90%(χ^2=5.77, P<0.05), the other indicators were not statistically different (P>0.05). 3.There were no statistically significant differences between the two groups in the men's simple weak sperm and normal semen(P>0.05). Conclusion 1.Primary infertility patients are younger than secondary infertility patients, but infertile years are longer. The normal fertilization rate of IVF is lower, but the clinical outcomes of the two groups are not statistically different. 2.With the prolongation of infertility, the risk of unfertilized or abnormal fertilization increases, and the probability of normal fertilization decreases. 3.In conventional IVF, the man's simple weak sperm can obtain the same clinical outcome as normal semen.