多囊卵巢综合征患者血清维生素D水平与IVF/ICSI-ET妊娠结局的关系

The Level of Serum Vitamin D and the Pregnancy Outcome of In-Vitro Fertilization/Intracytoplasmic Sperm Injection-Embryo Transplantation in Women with Polycystic Ovary Syndrome

目的:探讨多囊卵巢综合征(polycystic ovary syndrome,PCOS)患者血清维生素D水平与体外受精/胞浆内单精子注射(in-vitro fertilization/intracytoplasmic sperm injection,IVF/ICSI)治疗结局的关系。方法:回顾性分析2016年11月—2018年6月青岛大学附属烟台毓璜顶医院IVF/ICSI治疗的PCOS患者共286例,其中新鲜周期移植患者114例,根据患者血清25羟维生素D(25OHD)水平分为维生素D缺乏组(≤10 ng/mL)、不足组(10～30 ng/mL)和充足组(≥30 ng/mL),比较3组IVF/ICSI妊娠结局。新鲜周期移植患者按照临床妊娠结局分为临床妊娠组和未妊娠组,分析影响临床妊娠的因素;排除共线性,并校正年龄、基础黄体生成激素、基础睾酮水平、移植日子宫内膜厚度等混杂因素后,对血清维生素D水平与新鲜周期移植患者临床妊娠结局进行Logistic逐步回归分析。结果:(1)维生素D缺乏组、不足组及充足组间体质量指数(BMI)、基础睾酮、基础黄体生成激素/基础卵泡刺激素差异有统计学意义(P<0.05),3组间促排卵治疗指标差异均无统计学意义(P>0.05)。(2)新鲜周期移植患者维生素D缺乏组、不足组及充足组间BMI差异有统计学意义,维生素D缺乏组BMI高于维生素D不足组(P<0.05);3组间移植胚胎数差异无统计学意义(P>0.05),受精率及胚胎种植率差异有统计学意义(P<0.01)。(3)临床妊娠组患者基础黄体生成激素及基础睾酮水平低于未妊娠组(P<0.05);临床妊娠组移植日子宫内膜厚度及受精率均高于未妊娠组(P<0.05)。Logistic逐步回归分析显示,与血清维生素D缺乏组相比,不足组及充足组IVF/ICSI-ET临床妊娠率均升高(不足组:a OR=5.559,95%CI:1.463～21.124,P=0.012;充足组:a OR=11.192,95%CI:1.674～74.822,P=0.013)。结论:血清维生素D水平≥10 ng/mL是PCOS不孕女性IVF/ICSI-ET临床妊娠的保护因素。

Objective:To investigate the correlation between serum vitamin D and the pregnancy outcome of in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in women with polycystic ovary syndrome (PCOS).Methods:A total of 286 infertility women with PCOS underwent IVF/ICSI from November 2016 to June 2018 were included,including 114 women received fresh embryo transfer (ET).According to the level of 25-hydroxyvitamin D(25OHD),those patients were divided into three groups:vitamin D deficiency group (≤10 ng/mL),insufficiency group (10-30 ng/mL) and sufficiency group (≥30 ng/mL).The pregnancy rate of IVF/ICSI was analyzed.Furthermore,the patients with fresh ET were further divided into two groups:clinical pregnancy group and non-pregnancy group.After adjusting for baselines of luteinizing hormone (LH),testosterone and endometrial thickness on the ET day,logistic regression analysis on the vitamin D level and clinical pregnancy outcome of IVF/ICSI-ET was performed.Results:(1)There were significant differences in BMI,baseline testosterone,the ratio of baseline LH/FSH among three groups (P<0.05).There were no significant differences in the indicators of ovulation induction (P>0.05).(2)In those fresh ET patients,there were significant differences in BMI,the rate of fertilization and the rate of embryo implantation among three subgroups (P<0.05).(3) The baselines of LH and testosterone in the pregnancy group were lower than those in the non-pregnancy group (P<0.05),while the endometrial thickness on the ET day and the rate of fertilization in the pregnancy group were significantly higher than those in the non-pregnancy group (P<0.05).After adjusting for age,baseline LH,baseline testosterone,the endometrial thickness on the ET day and the ratio of baseline LH/FSH,the logistic regression analysis showed that the pregnancy rates in the vitamin D insufficiency group and the sufficiency group were significantly higher than this rate in the vitamin D deficiency group (aOR=5.559,95%CI:1.463-21.124,P=0.012;aOR=11.192,95%CI:1.674-74.822,P=0.013).Conclusions:The level of serum vitamin D≥10 ng/mL is a protective factor of IVF/ICSI-ET in women with PCOS.