低抗苗勒管激素女性行体外受精-胚胎移植累积分娩率及其影响因素探讨

Cumulative delivery rate and related factors of infertile women with low anti-Müllerian hormone level during in vitro fertilization and embryo transfer treatment

目的探讨抗苗勒管激素(anti-Müllerian hormone,AMH)≤1μg/L的女性行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)助孕的累积分娩率及其影响因素。方法回顾性队列研究分析2016年7月至2018年2月期间在河南省人民医院生殖医学中心首次接受IVF-ET助孕治疗的793例AMH≤1μg/L不孕女性的临床资料,根据每促排卵周期最终是否获得活胎分娩分为累积分娩组和未获得分娩组,比较两组间的一般情况,logistic回归分析影响累积分娩率的因素,并对不同年龄段的临床结局进行比较。结果①每起始周期累积分娩率为23.83%(189/793)。累积分娩组和未获得分娩组间患者年龄[33(30,37)岁比39(34,43)岁]、AMH[0.67(0.46,0.87)μg/L比0.51(0.22,0.74)μg/L]、窦卵泡计数(antral follicle count,AFC)[6(4,8)比4(2,6)]、基础卵泡刺激素(basal follicle-stimulating hormone,bFSH)[9.11(6.98,11.03)IU/L比11.06(7.75,13.13)IU/L]、促性腺激素(gonadotropin,Gn)起始用量[225.0(187.5,225.0)IU比225.0(225.0,300.0)IU]、Gn使用总量[2475.0(1800.0,3137.5)IU比2100.0(1575.0,2850.0)IU]、Gn使用时间[10(8,12)d比9(6,11)d]、获卵数[5.0(3.0,7.5)枚比2.5(1.0,4.0)枚]、MII卵数[4(3,6)枚比2(1,3)枚]及卵裂期可移植胚胎数[3.0(2.0,4.5)枚比1.0(0,2.0)枚]差异均有统计学意义(P均<0.001)。②多因素logistic回归分析显示,年龄(OR=0.878,95%CI=0.846~0.911,P<0.001)是累积分娩率的独立影响因素。对不同年龄段的分组分析显示,随着年龄的增加,每起始周期累积妊娠率及累积分娩率显著下降(P均<0.001),当年龄>40岁后无可利用胚胎周期取消率显著增高(P<0.001)。结论年龄是影响低AMH女性行IVF助孕累积分娩率的显著因素,累积分娩率随着年龄的增加逐渐降低。

Objective To explore the cumulative delivery rate and related factors of infertile women with anti-Müllerian hormone(AMH)no more than 1μg/L during in vitro fertilization and embryo transfer(IVF-ET)treatment.Methods In this retrospective cohort study,we analyzed 793 infertile women with AMH no more than 1μg/L and underwent their first IVF-ET treatment in Henan Provincial People's Hospital between July 2016 and February 2018.All the patients were categorized into two groups according to cumulative delivery with at least one live baby or not.Baseline data and outcomes were compared between the two groups.The regression analysis was conducted to identify the independent factors of cumulative delivery rate and clinical outcomes of different age groups were compared.Results 1)The total cumulative delivery rate per start cycle was 23.83%(189/793).There were significant differences in age[33(30,37)years vs.39(34,43)years],AMH[0.67(0.46,0.87)μg/L vs.0.51(0.22,0.74)μg/L],antral follicle count(AFC)[6(4,8)vs.4(2,6)],basal follicle-stimulating hormone(bFSH)[9.11(6.98,11.03)IU/L vs.11.06(7.75,13.13)IU/L],starting dosage of gonadotropin(Gn)used[225.0(187.5,225.0)IU vs.225.0(225.0,300.0)IU],total dosage of Gn used[2475.0(1800.0,3137.5)IU vs.2100.0(1575.0,2850.0)IU],duration of Gn stimulation[10(8,12)d vs.9(6,11)d],number of oocytes retrieved[5.0(3.0,7.5)vs.2.5(1.0,4.0)],number of MII oocytes[4(3,6)vs.2(1,3)]and number of available cleavage embryos[3.0(2.0,4.5)vs.1.0(0,2.0)]between the two groups(all P<0.001).2)Multivariate logistic regression analysis suggested that age(OR=0.878,95%CI=0.846-0.911,P<0.001)was the vital factor of cumulative delivery rate.The cumulative pregnancy rate and the cumulative delivery rate were significantly decreased with age increasing(all P<0.001).And the cancelation rate of group with age more than 40 years was much higher(P<0.001).Conclusion Age was the independent influencing factor of cumulative delivery rate.The cumulative delivery rate decreased significantly with age increasing.