子宫内膜异位症不孕患者不同体重指数对IVF-ET妊娠结局的影响

The influence of body mass index on pregnancy outcome of IVF-ET in infertile patients with endometriosis

目的分析子宫内膜异位症(EMS)不孕患者不同体重指数(BMI)对IVF/ICSI-ET妊娠结局的影响。方法回顾性分析2013年7月至2018年5月于武汉大学人民医院生殖中心行IVF/ICSI-ET助孕的427例EMS患者的临床资料,按照不同BMI(亚洲标准)分为4组:偏瘦组(60例,BMI<18.5 kg/m2)、正常体重组(289例,18.5 kg/m2≤BMI<24 kg/m2)、超重组(66例,24 kg/m2≤BMI<28 kg/m2)及肥胖组(12例,BMI≥28 kg/m2),比较各组患者的妊娠结局。并按照EMS分期分为Ⅰ~Ⅱ期亚组和Ⅲ~Ⅳ期亚组,比较不同BMI组中各亚组的妊娠结局。结果各组患者一般资料比较显示,偏瘦组的Ⅲ~Ⅳ期EMS比例最高,差异有统计学意义(P<0.01)。超重组的基础FSH、LH水平显著低于偏瘦组、正常体重组(P<0.05)。肥胖组的Gn用量显著高于其他3组(P<0.05)。正常体重组的获卵数显著高于偏瘦组和肥胖组(P均<0.05);肥胖组的2PN率显著高于其它3组(P均<0.05);肥胖组的卵裂率显著低于正常体重组、超重组(P均<0.05)。各组受精率、优胚率、鲜胚移植周期率等指标比较均无显著性差异(P均>0.05)。正常体重组中Ⅰ~Ⅱ期亚组的继续妊娠率、活产率显著高于偏瘦组和超重组中的Ⅰ~Ⅱ期亚组(P均<0.05)。偏瘦组中Ⅲ~Ⅳ期亚组的临床妊娠率显著低于超重组中的Ⅲ~Ⅳ期亚组(P<0.05),继续妊娠率、活产率比较则无显著性差异(P>0.05)。结论正常BMI的Ⅰ~Ⅱ期EMS患者IVF/ICSI-ET妊娠结局中继续妊娠率和活产率显著高于偏瘦、超重和肥胖组,正常BMI可能有助于改善Ⅰ~Ⅱ期EMS患者的助孕结局。

Objective:To investigate the influence of body mass index(BMI)on the pregnancy outcome of IVF/ICSI-ET in the infertile patients with endometriosis(EMS).Methods:The clinical data of 427 infertile patients with EMS in Center for Reproductive Medicine Renmin Hospital of Wuhan University from July 2013 to May 2018 were retrospectively analyzed.The patients were divided to four groups according to BMI:low body weight group(BMI<18.5 kg/m2,n=60),normal weight group(18.5 kg/m2≤BMI<24 kg/m2,n=289),overweight group(24 kg/m2≤BMI<28 kg/m2,n=66)and obesity group(BMI≥28 kg/m2,n=12).The general data and pregnancy outcomes were compared among the groups.Then,the patients were divided into stageⅠ-Ⅱsubgroups andⅢ-Ⅳsubgroups according to EMS staging,and the pregnancy outcomes of each subgroup in different BMI groups were compared.Results:The data analysis of each group suggested that the incidence of EMS of stage III-IV in low body weight group was the highest,which was significantly different with the other groups(P<0.001).The basal levels of FSH&LH in overweight group were significantly lower than those in low body weight group&normal weight group(P<0.05).The gonadotropin(Gn)dosage used in obesity group was significantly higher than that in other three groups(P<0.05).The number of oocytes retrieved in normal weight group was significantly higher than that in low body weight group and obesity group(P<0.05).The 2PN rate in obesity group was significantly higher than that in the other three groups(P<0.05).The cleavage rate in obesity group was significantly lower than that in normal weight group and overweight group(P<0.05).There were no significant differences in fertilization rate,high quality embryo rate,and fresh embryo transfer cycle rate among the groups(all P>0.05).The ongoing pregnancy rate and live birth rate in normal weight group with stageⅠ-Ⅱwas significantly higher than those in low body weight group&overweight group with stageⅠ-Ⅱ(P<0.05).The clinical pregnancy rate in the low body weight group with stageⅢ-Ⅳwas significantly lower than that in overweight group with stageⅢ-Ⅳ(P<0.05),and there was no significant difference in the ongoing pregnancy rate and live birth rate(P>0.05).Conclusions:The ongoing pregnancy rate and live birth rate in the infertile patients with normal BMI andⅠ-Ⅱstage EMS are significantly higher than those in the low weight group,overweight group and obesity group.Normal BMI may help improve fertility outcomes inⅠ~Ⅱstage EMS patients.