IVF/ICSI-ET/FET后自然流产的胚胎染色体异常的相关因素分析

Analysis of related factors of embryonic chromosome abnormalities of spontaneous abortions in IVF/ICSI-ET/FET

目的探讨体外受精(in vitro fertilization,IVF)、卵泡浆内单精子注射(intracytoplasmic sperm injection,ICSI)后新鲜胚胎移植(embryo-transfer,ET)及冷冻胚胎移植(frozen embryo transfer,FET)后自然流产的胚胎染色体异常的相关危险因素。方法选择2008年10月至2012年4月于南方医科大学南方医院生殖中心行IVF/ICSI-ET/FET后发生自然流产的夫妇115例,根据胚胎染色体结果分为异常组(74例)及正常组(41例),比较两组的一般资料及助孕相关指标间的差异并探讨胚胎染色体异常的相关危险因素。结果IVF/ICSI-ET/FET中自然流产绒毛染色体异常率为64.3%,以非整倍体率(91.9%)为主。胚胎染色体异常组的女性年龄显著高于正常组[(34.3±4.5)vs(32.2±4.5),P<0.05],促性腺激素(Gonadotrophin,Gn)总量显著高于后者[(2935.5±1418.5)vs(2398±1014.9),P<0.05],男性年龄亦高于后者[(37.1±4.9)vs(35.3±5.2),P>0.05],但差异无统计学意义。正常组的男女性别比为1∶2.4,女胎比例显著高于异常组(P<0.05)。IVF与ICSI的胚胎染色体异常类型差异无统计学意义(P>0.05)。Logistic回归分析提示仅女性年龄为胚胎染色体异常的独立危险因素(OR:1.008~1.204)。结论胚胎染色体异常是IVF/ICS-ET/FET后自然流产的主要原因,但细胞培养法可能会降低胚胎染色体异常的检出率。女性年龄是胚胎染色体异常的独立危险因素,而IVF/ICS-ET/FET治疗并不增加胚胎染色体异常的风险。

Objective To explore related factors of embryonic chromosome abnormalities of spontaneous abortions of in vitro fertilization(IVF),intracytoplasmic sperm injection(ICSI)-embryo transfer(ET)or frozen embryo transfer(FET).Methods 115 couples suffering clinical spontaneous abortions after IVF/ICS-ET/FET therapy from October 2008 to April 2012 in Reproductive Medicine Center,Department of Obstetrics and Gynecology,Nanfang Hospital,Southern Medical University were selected and divided into abnormal group(74 cases)and normal group(41 cases)according to embryo chromosome karyotypes.Differences in general information and indicators related to reproductive technology were compared between the two groups and risk factors related to embryonic chromosome abnormalities were explored.Results The embryonic chromosome abnormality rate of spontaneous abortions after IVF/ICSI-ET/FET treatment was 64.3%,mainly in aneuploids(91.9%).The maternal age in the abnormal group was significantly higher than that in the normal group[(34.3±4.5)vs(32.2±4.5),P<0.05],meanwhile significantly higher in the Gonadotropin(Gn)consumption[(2935.5±1418.5)vs(2398±1014.9),P<0.05)],whereas the paternal age was also higher[(37.1±4.9)vs(35.3±5.2),P<0.05],but without statistical significance.The sex ratio of male to female in the normal group was 1∶2.4,significantly higher in the proportion of female fetuses than that in the abnormal group(P<0.05).No statistical difference was found in the types of embryonic chromosome abnormalities between IVF and ICSI(P>0.05).Logistic regression analysis suggested that only female age was an independent risk factor for embryonic chromosome abnormalities(OR:1.008~1.204).Conclusions Embryonic chromosome abnormalities is the main cause of spontaneous abortion after IVF/ICS-ET/FET,but cell culture methods may reduce the detection rate of embryonic chromosome abnormalities.Maternal age is an independent risk factor for embryonic chromosome abnormalities,whereas treatment with IVF/ICS-ET/FET do not increase the risk of embryonic chromosome abnormalities.