卵巢低反应患者行体外受精后累积活产率的影响因素

Influencing factors of cumulative live birth rate in patients with poor ovarian response undergoing in vitro fertilization

目的探讨卵巢低反应(POR)人群行多周期体外受精(IVF)的累积活产率及其影响因素.方法回顾性分析2002年至2016年期间华中科技大学同济医学院附属同济医院生殖医学中心行IVF-胚胎移植(ET)、并符合博洛尼亚标准的3391例POR患者临床资料,计算其单周期累积活产率和多周期累积活产率,采用Kaplan-Meier(KM)曲线评估乐观累积活产率和保守累积活产率,并通过logistic多元回归分析累积活产率的影响因素.结果经过6个IVF周期后POR人群的保守累积活产率为14.9%,乐观累积活产率为35.3%.随着该人群年龄的增长,其累积活产率下降.当年龄>43岁时,累积活产率急剧下降(4.4%).Logistic多元回归分析去除窦卵泡数(AFC)、基础卵泡刺激素(FSH)水平、IVF次数和不同促排卵方案等混淆因素,结果显示>38岁女性的累积活产率显著低于<35岁女性(P<0.01).Logistic多元回归分析排除年龄、AFC、基础FSH水平和IVF次数等混淆因素后,结果表明与标准长方案相比,拮抗剂方案及黄体期促排卵方案的单周期累积活产率增高(OR=1.47,95%CI=1.13~1.90,P=0.004;OR=1.42,95%CI=1.01~2.01,P=0.04);自然周期方案活产率较其他方案低,差异有统计学意义(P均<0.05).结论对于POR人群,其累积活产率根据年龄增长而下降.>38岁女性的累积活产率显著低于<35岁女性,尤其是年龄>43岁患者的累积活产率急剧下降.自然周期方案对于POR人群无益处.

Objective To investigate the cumulative live birth rate (CLBR) and its influencing factors of multiple cycles in vitro fertilization (IVF) in patients with poor ovarian response (POR). Methods From 2002 to 2016, a total of 3391 women with POR undergoing IVF-embryo transfer (ET) in Reproductive Medicine Center of Tongji Hospital, Tongji Medicine College, Huazhong University of Science and Technology were analyzed retrospectively. Live birth rates per initiated cycle and CLBR for multiple IVF cycles were calculated. The conservative CLBR and optimistic CLBR were measured by Kaplan-Meier (KM) curve. The influencing factors of CLBR were analyzed by logistic multiple regression. Results The CLBR after 6 IVF cycles were 14.9% for the conservative estimate and 35.3% for the optimistic estimate. CLBR declined with increasing age. At age > 43 years, CLBR decreased sharply (4.4%). After adjusting for antral follicle count (AFC), basal follicle stimulating hormone (FSH) level, IVF cycle number and ovarian stimulation protocols, the CLBR of > 38 years old women was significantly lower than that of < 35 years old women (P<0.01). After adjusting for age, AFC, basal FSH level, and IVF cycle number, compared with the standard long regimen, the single cycle CLBR of antagonist regimen and luteal stimulating regimen were higher (OR=1.47, 95% CI=1.13-1.90, P=0.004;OR=1.42, 95% CI=1.01-2.01, P=0.04);natural cycles were associated with the lowest CLBR among all the protocols, and this difference was significant compared with the other protocols (all P<0.05). Conclusion For women with POR, the CLBR declined with increasing age. Women with advanced age (> 38 years) achieved a significantly lower CLBR than that in young POR women (< 35 years). Very low CLBR was associated with women aged > 43 years. Natural cycle IVF is of no benefit for these patients.