供精人工授精后早期妊娠丢失的影响因素分析

Analysis of influential factors of early pregnancy loss after artificial insemination with donor sperm

目的探讨供精人工授精(AID)助孕后早期妊娠丢失的影响因素。方法回顾性分析2012年1月至2018年12月于我中心接受AID助孕后获宫内妊娠的1149个周期的超声监测数据及临床资料。按宫内妊娠情况分为早期妊娠丢失组(n=117)和持续妊娠组(n=1032),比较两组女方的基本资料及周期相关参数,采用多因素Logistic回归分析探索早期妊娠丢失的影响因素,应用ROC曲线确定孕前BMI预测早期妊娠丢失的临界值。再按女方孕前BMI分为偏瘦(BMI<18.5 kg/m2)、正常(BMI 18.5~23.9 kg/m2)、超重(BMI 24.0~27.9 kg/m2)及肥胖(BMI≥28.0 kg/m2)4组,检测早期妊娠丢失率随孕前BMI升高的变化趋势。结果本研究中所回顾周期的早期妊娠丢失率为10.18%(117/1149)。早期妊娠丢失组女方孕前BMI显著高于持续妊娠组[(22.21±3.06)vs.(21.55±2.63)kg/m2](P<0.05),而组间女方年龄、原发不孕/继发不孕、周期序号平均值、卵泡期天数、优势卵泡直径、排卵日子宫内膜厚度均无显著性差异(P>0.05)。Logistic回归分析显示孕前BMI是早期妊娠丢失的显著预测因子(OR=1.079,P<0.05)。根据ROC曲线,孕前BMI预测早期妊娠丢失的临界值约为24.0 kg/m2;早期妊娠丢失率随孕前BMI分级的升高呈显著的线性递增趋势(χ2=7.523,P<0.05)。结论孕前BMI升高是AID后早期妊娠丢失的独立危险因素;人工授精前女方应将BMI控制在正常范围。

Objective:To investigate the influential factors of early pregnancy loss(EPL)after artificial insemination with donor sperm(AID).Methods:The data of ultrasound monitoring and clinical outcome of 1149 AID cycles performed in our reproductive center and achieved intrauterine pregnancy from January 2012 to December 2018 were retrospectively analyzed.According to the intrauterine pregnancy status,they were divided into EPL group(n=117)and ongoing pregnancy group(n=1032).The woman’s basic data and cycle-related parameters were compared between the two groups.The influential factors of EPL were explored by multivariate logistic regression analysis,and ROC curve was used to determine the cutoff value of pre-pregnancy BMI for predicting EPL.According to the woman’s pre-pregnancy BMI,the patients were subdivided into four groups:underweight(<18.5 kg/m2),normal(18.5-23.9 kg/m2),overweight(24.0-27.9 kg/m2)and obesity(≥28.0 kg/m2)groups,in order to detect the trend of early pregnancy loss rate with the increase of pre-pregnancy BMI.Results:The overall EPLR was 10.18%(117/1149)in the study.Woman’s pre-pregnancy BMI in EPL group was significantly higher than that in ongoing pregnancy group[(22.21±3.06)vs.(21.55±2.63)kg/m2](P<0.05).There was no significant difference in woman’s age,primary infertility/secondary infertility ratio,average of serial number,days of follicular phase,diameter of dominant follicles,endometrial thickness on ovulation day between the two groups(P>0.05).Logistic regression analysis showed that woman’s pre-pregnancy BMI was a significant predictive factor for EPL(aOR=1.079,P<0.05).According to the ROC curve,the cutoff value of pre-pregnancy BMI for predicting EPL was 24.0 kg/m2.EPL rate showed a significant linear increasing trend with the increase of pre-pregnancy BMI grade(χ2=7.523,P<0.05).Conclusions:Elevated pre-pregnancy BMI is an independent risk factor for EPL after AID.Woman’s BMI should be controlled within the normal range before artificial insemination.