鲜胚移植后发生异位妊娠的危险因素

Risk factors of ectopic pregnancy after fresh embryo transfer

目的分析鲜胚移植后发生异位妊娠的危险因素。方法进行体外受精-胚胎移植并获得临床妊娠的4195个新鲜胚胎移植(鲜胚移植)周期,根据妊娠结局分为异位妊娠组(80个周期)和宫内妊娠组(4115个周期),观察并比较两组患者的一般资料[年龄、体质量指数(BMI)]、卵巢功能指标[抗苗勒氏管激素(AMH)、促卵泡生成激素(FSH)、窦卵泡(AFC)数目]、不孕因素(输卵管因素、非输卵管因素)、既往异位妊娠史、促排卵周期情况[促性腺激素(Gn)总量、绒毛膜促性腺激素(HCG)日雌二醇(E2)水平、HCG日子宫内膜厚度]、辅助生殖实验室情况[受精方式(IVF或ICSI)、鲜胚移植时间(第3天或第5天)、胚胎移植数目(1个或2个)],采用二分类Logistic回归分析法分析鲜胚移植后发生异位妊娠的危险因素。结果异位妊娠组输卵管因素导致不孕者、HCG日E2水平≥3500 pg/m L者、HCG日子宫内膜厚度<0.9 cm者、第3天鲜胚移植者、移植胚胎数目2个者与宫内妊娠组相比,P均<0.05。输卵管因素导致不孕、HCG日E2水平≥3500 pg/m L、HCG日子宫内膜厚度<0.9 cm、第3天鲜胚移植是鲜胚移植后发生异位妊娠的独立影响因素(P均<0.05)。结论输卵管因素导致不孕、HCG日E2水平≥3500 pg/m L、HCG日子宫内膜厚度<0.9 cm、第3天鲜胚移植是鲜胚移植后发生异位妊娠的危险因素。

Objective To investigate the related factors of ectopic pregnancy after fresh embryo transfer.Methods According to the pregnancy outcome,4195 cycles of clinical pregnancy after finishing fresh embryo transfer were divided into the ectopic pregnancy group(80 cycles)and intrauterine pregnancy group(4115 cycles).General data[age,body mass index(BMI)],ovarian function indicators(AMH,FSH,AFC),infertility factors(tubal factors,non-tubal factors),history of previous ectopic pregnancy,controlled ovarian hyperstimulation cycle[dosage of gonadotropin(Gn),E2 level on HCG day,endometrial thickness on HCG day],laboratory conditions of assisted reproduction[fertilization mode(IVF or ICSI),days of embryo transfer(day 3 or day 5),and number of embryo transfer(1 or 2)]were observed and compared between the two groups.Then the possible related factors of ectopic pregnancy were analyzed by Logistic multivariate method.Results Compared with the intrauterine pregnancy group,the patients of tubal factors,the patients of E2 level≥3500 pg/m L in the HCG day,the patients of endometrial thickness<0.9 cm in the HCG day,the patients of D3 embryo transfer and patients who had transferred 2 embryos in the ectopic pregnancy group were significantly higher than those of the intrauterine pregnancy group(all P<0.05).The tubal factors,E2 level≥3500 pg/m L on the HCG day,endometrial thickness<0.9 cm on the HCG day and D3 embryo transfer were independent risk factors for ectopic pregnancy after fresh embryo transfer.Conclusion The tubal factors,E2 level≥3500 pg/m L on the HCG day,endometrial thickness<0.9 cm on the HCG day and D3 embryo transfer were independent risk factors for ectopic pregnancy after fresh embryo transfer.