长方案IVF/ICSI周期中女性年龄和获卵数对妊娠结局的影响

Impact of female age and number of oocytes retrieved on clinical outcome of IVF/ICSI with long protocol of controlled ovarian hyperstimulation

目的探讨长方案IVF/ICSI-ET助孕周期中患者年龄、获卵数对妊娠结局的影响。方法选取2011年7月至2016年7月在本院生殖科首次接受黄体期长方案助孕治疗的1763例患者为研究对象(共1763个取卵周期),并根据是否获得活产将研究对象分为活产组和非活产组;根据助孕年龄不同分为<25岁、25~29岁、30~34岁、≥35岁4组;根据获卵数不同分为≤5个、6~10个、11~15个、16~20个、≥21个5组。比较各组间的一般情况、实验室指标以及妊娠结局。结果(1)1763个取卵周期中分娩活婴1036个周期,累计活产率58.76%,其中新鲜移植1438个周期,541个周期分娩活婴,新鲜移植活产率为37.62%。活产组与非活产组比较,活产组的年龄、不孕年限、基础FSH(bFSH)、Gn使用总量显著低于非活产组(P<0.05);而HCG日E2水平、获卵数、卵母细胞成熟率、受精率、可利用胚胎率、优质胚胎率均显著高于非活产组(P<0.05)。(2)不同年龄组的比较:随着年龄的增加所需Gn总量也增加,<25岁组的受精率最低,30~34岁组的可利用胚胎率最高;≥35岁组的bFSH水平显著高于其他组,而HCG日E2水平、获卵数、优质胚胎率、新鲜移植活产率及累计活产率均显著低于其他组(P均<0.05)。(3)不同获卵数组间比较:获卵数≤10个两组的年龄、bFSH、Gn总量均显著高于获卵数≥16个两组,但HCG日E2水平、新鲜移植活产率、累计活产率均显著低于获卵数≥16个两组;获卵数≥21个组的新鲜移植活产率及累计活产率最高(P均<0.05)。(4)不同年龄不同获卵数组间比较:各个年龄组的不同获卵数间的累计活产率均随着获卵数的增加而增加。结论(1)年龄是影响IVF/ICSI妊娠结局的重要因素,年龄过小或过大均影响IVF/ICSI妊娠结局;(2)获卵数是影响IVF/ICSI妊娠结局的另一重要因素,在一定范围内获卵数的增加能改善妊娠结局;(3)不同年龄段获得较满意的妊娠结局所需的最适获卵数范围不同;(4)累计活产率是评价IVF/ICSI妊娠结局的重要指标。

Objective:To explore the effect of female age and the number of oocytes retrieved on the clinical outcome of IVF/ICSI with the long protocol of controlled ovarian hyperstimulation.Methods:A total of 1 763 patients(1 763 IVF/ICSI cycles)treated in the Reproductive Medicine Center of our hospital from July 2011 to July 2016 were included in the retrospective study.The patients were divided into two groups according to clinical outcomes:live-birth group and non-live-birth group;and the patients were divided into four groups according to female age:<25,25-29,30-34 and≥35 years old.In addition,the patients were divided into five groups according to the number of oocytes retrieved:≤5,6-10,11-15,16-20 and≥21 oocytes.The general characteristic and laboratory indexes and main clinical outcomes were compared among the groups.Results:(1)There were 1 036 cycles of delivering live babies in 1 763 oocytes retrieval cycles,and the total live birth rate was 58.76%.Among them,1 438 cycles were fresh transfer cycles,and 541 fresh cycles had live birth with the live birth rate of 37.62%.Female age,infertility years,basic FSH level and total gonadotropin(Gn)used in the live-birth group were significantly lower than those in the non-live-birth group(P<0.05).However,the serum estradiol level on HCG day,number of oocytes retrieved,oocyte maturity rate,fertilization rate,available embryo rate and high-quality embryo rate in the live-birth group were significantly higher than those in the non-live-birth group(P<0.05).(2)The total amount of Gn used was increased along with the increase of age.The fertilization rate was the lowest in<25 years old group.The available embryo rate was the highest in the 30-34 years old group.The basic FSH level in≥35 years old group was significantly higher than that in the other age group(P<0.05),and the serum estradiol level on HCG day,the number of oocytes retrieved,the high-quality embryo rate,the live birth rate and the cumulative live birth rate of fresh transfer cycles were significantly lower than those in the other groups(P<0.05).(3)The female age,basic FSH and total Gn used were significantly higher,but the serum estradiol level on HCG day,the live birth rate and cumulative live birth rate of fresh transfer cycles were significantly lower in the two groups with the number of oocytes retrieved less than 10 than those in the two groups with the number of oocytes retrieved more than 16.The live birth rate and cumulative live birth rate of fresh transfer cycles were the highest in the group with the number of oocytes retrieved more than 21(P<0.05).(4)The cumulative lire birth rate was increased along with the increase of number of oocytes retrieved.Conclusions:(1)Female age is an important factor affecting the outcome of IVF/ICSI,too young or too old affects the outcome of IVF/ICSI pregnancy.(2)The number of oocytes retrieved is another important factor affecting the pregnancy outcome of IVF/IVSI.In a certain range,the pregnancy outcomes of IVF/ICSI are improved with the increase of the number of oocytes retrieved.(3)The optimum number of oocytes retrieved is different for achieving the satisfactory pregnancy outcomes in different age groups.(4)The cumulative live birth rate is an important index to evaluate the pregnancy outcome of IVF/ICSI.