POR患者胚胎发育迟缓的相关因素分析

Analysis of related factors of embryo developmental delay in POR patients

目的:探讨卵巢低反应(POR)患者发生胚胎发育迟缓的相关因素。方法:回顾分析2014年1月至2018年12月在首都医科大学附属北京妇产医院生殖医学科行体外受精-胚胎移植(IVF-ET)的1207个周期POR患者的临床资料,分为发育迟缓组(n=372)和发育正常组(n=835),比较两组患者的一般情况、促排卵情况、临床妊娠、种植率及活产率等相关指标,并将胚胎发育迟缓的影响因素年龄进行归因危险度(AR)分析。结果:发育迟缓组患者的年龄显著高于发育正常组(P=0.026),种植率、临床妊娠率和活产率均显著低于发育正常组(P=0.000)。两组患者按年龄分为高龄组(≥35岁)和低龄组(<35岁),结果显示高龄患者发生胚胎发育迟缓的危险性高于低龄患者(χ^2=4.403,P=0.036),AR=5.5%。将发育迟缓组患者按妊娠结局分为未孕组和临床妊娠组,结果显示高龄患者移植发育迟缓胚胎患者不孕的危险性高于低龄患者(χ^2=6.193,P=0.013),AR=9.9%。结论:高龄(≥35岁)是引起胚胎发育迟缓及导致移植发育迟缓胚胎患者不孕的危险因素。POR患者移植发育迟缓的胚胎仍可获得一定的临床妊娠率和活产率。

Objective:To explore the related factors of embryo developmental delay in patients with poor ovarian response(POR).Methods:From January 2014 to December 2018,a retrospective study was performed in 1207 POR cycles in which underwent in vitro fertilization-embryo transfer(IVF-ET)in the Department of Reproductive Medicine,Beijing Obstetrics and Gynecology Hospital,Capital Medical University.We compared clinical pregnancy,implantation and live birth rates between IVF-ET cycles using delayed cleavage-stage embryos(n=372)and normal cleavage-stage embryos(n=835).And the attribution risk(AR)was performed to analyze the effect of age on embryo developmental delay.Results:The age of the developmental delay group was significantly higher than the normal development group(P=0.026),and no difference in other clinical indicators.The implantation rate,clinical pregnancy rate and live birth rate of the developmental delay group were significantly lower than those of the normal development group(P=0.000).The two groups of patients were divided into advanced age group(≥35 years old)and young group(<35 years old),and the results of showed that the risk of embryo developmental delay in advanced age patients was higher than that in young patients(χ^2=4.403,P=0.036),and AR=5.5%.In addition,patients of delayed cleavage-stage embryos were divided into non-pregnant group and clinical pregnancy group.The results showed that the risk of unpregnancy in patients with embryo developmental delay caused by advanced age was higher than that in the young group(χ^2=6.193,P=0.013),and AR=9.9%.Conclusion:Advanced age(≥35 years old)is a risk factor for embryo developmental delay,and it is a risk factor for unpregnancy in transplanted embryos with developmental delay.It is worth transferring the delayed embryos as they provide a non-negligible chance to give rise to a pregnancy rate and live birth rate in patients with POR.