影响IVF/ICSI优胚率的临床因素及助孕结局差异分析

Analysis of clinical factors affecting IVF/ICSI high-quality embryo rate and differences in assisted pregnancy outcomes

目的分析IVF/ICSI周期中影响优胚率的临床因素及不同优胚率患者的助孕结局。方法回顾性分析2015年1月至2018年12月在本院生殖部就诊的IVF/ICSI-ET患者资料。共纳入患者927例,按照优胚率分为5组,分别为A组(优胚率≤20%,n=103)、B组(20%<优胚率≤40%,n=116)、C组(40%<优胚率≤60%,n=177)、D组(60%<优胚率≤80%,n=223)和E组(优胚率>80%,n=308),分析不同组间患者的临床特点、促排卵情况以及移植结局等的差异。结果A组基础FSH水平、Gn总量、Gn启动剂量均显著高于其余4组,而AMH水平、获卵数、MⅡ卵率均显著低于其他4组(P<0.05);各组间鲜胚移植结局无显著差异(P>0.05);A组无可移植胚胎者62例,其有可移植胚胎的41个取卵周期的累积活产率为21.95%,显著低于D、E组(P<0.05);随着优胚率的增高,累积活产率逐渐上升,D、E组累积活产率显著高于A组(P<0.05),但D、E组间无显著差异(P>0.05)。结论优胚率≤20%可能与患者的AMH、基础FSH等临床因素有关,并影响累积活产率。

Objective:To analyze the clinical factors affecting the high-quality embryo rate during IVF/ICSI cycle and the outcome of assisted pregnancy in patients with different high-quality embryo rates.Methods:The data of IVF/ICSI-ET patients who visited the reproductive department of our hospital from January 2015 to December 2018 were retrospectively analyzed.A total of 927 patients were included and divided into 5 groups according to the rate of high-quality embryos:group A(≤20%,n=103),group B(20%<rate≤40%,n=116),group C(40%<rate≤60%,n=177),group D(60%<rate≤80%,n=223)and group E(>80%,n=308).The differences in clinical characteristics,ovulation induction and pregnancy outcome after embryo transfer were compared among the different groups.Results:The basic FSH level,total Gn dose,and Gn starting dose of group A were significantly higher than those of the other four groups,while the AMH level,number of oocytes retrieved,and MⅡoocyte rate were significantly lower than those of the other four groups(P<0.05).There was no significant difference in the outcome of fresh embryo transfer among the groups(P>0.05).The cumulative live birth rate of group A(41 occyte pick-up cycles with transferrable embryos)was 21.95%,which was significantly lower than that of group D or group E(P<0.05).With the increase of the high-quality embryo rate,the cumulative live birth rate gradually increased.The cumulative live birth rate in group D or E was significantly higher than that in group A(P<0.05),but there was no significant difference between group D and group E(P>0.05).Conclusions:The high-quality embryo rate≤20%may be related to the clinical factors such as AMH and basic FSH,and affects the cumulative live birth rate.