子宫内膜异位症不孕症患者行体外受精-胚胎移植术后妊娠结局及影响因素分析

Analysis of pregnancy outcomes and influencing factors in infertility patients with endometriosis after in vitro fertilization and embryo transfer

目的分析子宫内膜异位症(endometriosis,EM)不孕症患者行体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)术后妊娠结局及其影响因素。方法回顾性分析2018年1月至2020年1月在本院接受IVF-ET助孕的EM不孕症患者资料,从中选取148例纳入研究,年龄20~42岁,根据患者妊娠结局划分为成功组和失败组。对比两组患者一般资料、促排卵资料,分析影响妊娠结局的相关因素。结果本组148例EM不孕患者IVF-ET助孕后,种植率为50.00%(74/148),临床妊娠率为46.62%(69/148);剔除相关病例后成功组纳入47例患者,失败组纳入79例患者。两组EM不孕患者年龄、不孕症病程、BMI、基础卵泡刺激素(FSH)水平比较,差异均无统计学意义(均P>0.05);成功组窦卵泡数为(10.55±4.68)个,高于失败组的(6.27±2.70)个,差异有统计学意义(P<0.05);成功组促排卵时间、促性腺激素(Gn)总量、人绒毛膜促性腺激素(HCG)日雌二醇(E2)水平、HCG日内膜厚度、获卵数分别为(9.25±1.38)d、(1825.70±103.93)IU、(2960.32±148.74)pg/ml、(10.05±1.05)mm、(10.70±2.84)个,均优于失败组的(11.16±1.67)d、(2545.29±136.21)IU、(2196.90±148.07)pg/ml、(11.04±1.39)mm、(6.43±1.86)个,差异均有统计学意义(均P<0.05);两组EM不孕患者正常受精率、优质胚胎率比较,差异均无统计学意义(均P>0.05)。获卵数、窦卵泡数为EM不孕患者IVF-ET助孕后成功妊娠的保护因素(均OR<1,P<0.05),促排卵时间、HCG日内膜厚度为EM不孕患者IVF-ET助孕后妊娠失败的危险因素(均OR>1,P<0.05)。结论EM不孕症患者行IVF-ET前,应尽量改善患者的卵巢功能、提高子宫内膜容受性以提高妊娠成功率。

Objective To analyze the pregnancy outcomes and influencing factors of infertility patients with endometriosis(EM)after in vitro fertilization and embryo transfer(IVF-ET).Methods A retrospective analysis was carried out on the clinical data of 148 infertility patients with EM aged 20-42 who received IVF-ET in our hospital from January 2018 to January 2020,who were divided into a successful group and a failed group based on the pregnancy outcomes.The general information,ovulation induction data of the two groups were compared,and the related factors that affected the pregnancy outcomes were analyzed.Results In the study,after 148 infertility patients with EM received IVF-ET,the implantation rate was 50.00%(74/148),and the clinical pregnancy rate was 46.62%(69/148);47 patients were included in the successful group and 79 patients in the failed group after the exclusion of relevant cases.There were no statistically significant differences in the age,course of infertility,BMI,basic follicle stimulating hormone(FSH)level between the two groups(all P>0.05);the number of antral follicles in the successful group was higher than that in the failed group[(10.55±4.68)vs.(6.27±2.70)](P<0.05);the duration of ovulation induction,gonadotropin(Gn)volume,estradiol(E2)level on human chorionic gonadotropin(HCG)day,endometrial thickness on HCG day,retrieved oocyte number in the successful group were(9.25±1.38)d,(1825.70±103.93)IU,(2960.32±148.74)pg/ml,(10.05±1.05)mm,(10.70±2.84),which were better than those in the failed group[(11.16±1.67)d,(2545.29±136.21)IU,(2196.90±148.07)pg/ml,(11.04±1.39)mm,(6.43±1.86)](all P<0.05);there were no statistically significant differences in the normal fertilization rate and high quality embryo rate between the two groups(both P>0.05).The number of antral follicles and retrieved oocyte number were the protective factors of successful pregnancy in infertility patients with EM who received IVF-ET(both OR<1,P<0.05),the duration of ovulation induction and endometrial thickness on HCG day were the risk factors of pregnancy failure in infertility patients with EM who received IVF-ET(both OR>1,P<0.05).Conclusion Before IVF-ET,the ovarian function and endometrial receptivity of infertility patients with EM should be improved to increase the successful rate of pregnancy.