常规体外受精与卵泡浆内单精子注射中异常受精胚胎形成的影响因素分析

INFLUENCING FACTORS FOR THE FORMATION OF ABNORMAL FERTILIZED EMBRYO DURING ROUTINE IN VITRO FERTILIZATION AND INTRACYTOPLASMIC SPERM INJECTION

目的分析常规体外受精(IVF)和卵胞浆内单精子注射(ICSI)中异常受精胚胎形成的影响因素。方法回顾性分析2019年1月—2020年5月于山东中医药大学附属医院中西医结合生殖与遗传中心行常规IVF/ICSI助孕的1018个周期患者的临床资料,按照是否存在异常受精分为异常受精组(n=871)和对照组(n=147),对两组患者的一般情况和临床资料进行比较,并通过多因素Logistic回归分析分析异常受精胚胎形成的相关影响因素。结果单因素分析结果显示,两组女方年龄、基础卵泡刺激素(bFSH)、基础雌二醇(bE_(2))、用药方案、前向精子运动率(PR)、人绒毛膜促性腺激素(hCG)日E_(2)水平和实验室受精方式比较,差异均有统计学意义(χ^(2)=6.674~74.908,P<0.05)。多因素Logistic回归分析表明,女方年龄≥31岁、hCG日E_(2)水平>3000 ng/L是异常受精胚胎形成的危险因素;黄体期长方案、ICSI的受精方式是异常受精胚胎形成的保护因素。结论女方年龄、hCG日E_(2)水平、用药方案、实验室受精方式均与常规IVF/ICSI中异常受精胚胎的形成相关,提示临床工作者可采取相应的预防及治疗措施,以提高卵母细胞的利用率,减少胚胎浪费。

Objective To investigate the influencing factors for the formation of abnormal fertilized embryo during routine in vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI).Methods A retrospective analysis was performed for the clinical data of the patients who underwent a total of 1018 cycles of routine IVF/ICSI to promote pregnancy in Center for Integrated Reproduction and Genetics of Traditional Chinese and Western Medicine,The Affiliated Hospital of Shandong University of Traditional Chinese Medicine,from January 2019 to May 2020,and according to the presence or absence of abnormal fertilization,the 1018 cycles were divided into abnormal fertilization group with 871 cycles and control group with 147 cycles.General status and clinical data were compared between the two groups,and a multivariate logistic regression analysis was used to investigate the influencing factors for the formation of abnormal fertilized embryo.Results The univariate analysis showed that there were significant differences between the two groups in woman’s age,basal follicle-stimulating hormone,basal estradiol(E_(2)),medication regimen,forward sperm motility,E_(2) level on the day of human chorionic gonadotropin(hCG)injection,and laboratory fertilization method(χ^(2)=6.674-74.908,P<0.05).The multivariate logistic regression analysis showed that woman’s age≥31 years and E_(2) level>3000 ng/L on the day of hCG injection were risk factors for the formation of abnormal fertilized embryo,while long-luteal phase regimen and ICSI fertilization were protective factors against the formation of abnormal fertilized embryo.\ConclusionWoman’s age,E_(2) level on the day of hCG injection,medication regimen,and laboratory fertilization method are associated with the formation of abnormal fertilized embryo during routine IVF/ICSI,suggesting that clinical workers should take corresponding preventive and therapeutic measures to improve the utilization rate of oocytes and reduce embryo waste.