体外受精-胚胎移植中受精失败的相关因素

Identification of factors related to fertilization failure in in vitro fertilization-embryo transfer

目的:探讨体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)中受精失败的相关因素。方法:收集2016年1月至2017年12月在中南大学湘雅医院生殖医学中心进行IVF-ET治疗的4205例不孕患者病历资料,根据受精情况分为完全受精失败组、低受精率组及对照组,分析3组相关临床资料[女方年龄、不孕年限、促排天数、促性腺激素(gonadotrophin,Gn)用量、卵泡刺激素(follicle-stimulating hormone,FSH)用量及总获卵数]之间的相关性;根据发病因素分为女方因素、男方因素及双方因素,分析不同组别之间发病因素的相关性;根据不孕类型分为原发不孕及继发不孕,分析不同组别之间不孕类型的相关性。采用多元线性逐步回归法分析IVF-ET中完全受精失败及低受精率的危险因素。结果:原发不孕、不孕年限、总获卵数及双方因素与IVF-ET完全受精失败及低受精率的发生相关(均P<0.05),但女方年龄、促排天数、FSH用量及Gn用量与IVF-ET完全受精失败及低受精率的发生不相关(均P>0.05)。多元线性回归分析示发病因素、不孕类型及不孕年限都是完全受精失败及低受精率的独立影响因素。结论:IVF-ET完全受精失败及低受精率的发生与不孕年限、总获卵数、发病原因和不孕类型等相关,未观察到与女方年龄、促排天数、Gn用量及FSH用量等相关。

Objective:To investigate the possible factors relevant to fertilization failure in in vitro fertilization-embryo transfer(IVF-ET).Methods:The medical records of 4205 infertile patients undergoing IVF-ET treatment at the Reproductive Medicine Center,Xiangya Hospital,Central South University from January 2016 to December 2017 were collected.The patients were divided into a complete fertilization failure group,a low fertilization rate group,and a control group based on fertilization rate.We examined the associations among the 3 groups in terms of female age,duration of infertility,duration of stimulation,gonadotropin(Gn)dosage,folliclestimulating hormone(FSH)dosage,and total number of retrieved oocytes.According to theincidence factors,the patients were divided into a single female factor group,a single male factor group and a unisex factor group,and the correlation analysis of incidence factor among the 3 groups was performed.The patients were divided into a primary infertility and a secondary infertility in accordance with the type of infertility.We analyzed the correlation of infertility type among the three groups.Risk factors for complete fertilization failure and low fertilization rate in IVF-ET were obtained by stepwise multiple linear regression analysis.Results:Primary infertility,long infertility duration,total number of retrieved oocytes,and unisex factor were associated with completefertilization failure and low fertilization rate in IVF-ET(P<0.05),but female age,duration of stimulation,FSH dosage as well as Gn dosage were not correlated with complete fertilization failure and low fertilization rate in IVF-ET(P>0.05).Stepwise multiple linear regression analysis showed that the incidence factor,type of infertility,and infertility duration were independent influential factors for complete fertilization failure and low fertilization rate.Conclusion:Complete fertilization failure and low fertilization rate in IVF-ET are related to duration of infertility,total number of retrieved oocytes,cause of onset,and type of infertility,but they are not relevant to female age,duration of stimulation,and Gn and FSH dosage.