不同年龄段不孕女性成熟卵母细胞冷冻复苏效果的影响因素分析

Influencing factors of the effect of oocyte resuscitation of mature oocytes cryopreservation in infertile women with different age

目的:探究人成熟卵母细胞冷冻复苏效果的影响因素,为临床决策提供参考。方法:回顾性分析2007年8月-2019年12月在本院行辅助生殖技术,取卵日因男方因素接受成熟卵母细胞玻璃化冷冻保存并解冻的临床资料(共2691枚卵母细胞)。解冻后卵母细胞分为存活组(2003例)和未存活组(688例),按年龄分为<35岁组(2297例)和≥35岁(394例),采用单因素及多因素logistics回归分析影响卵母细胞复苏的危险因素。结果:卵母细胞解冻存活率为74.4%(2003/2691)。女方高龄(OR=0.94,95%CI 0.91~0.97)、窦卵泡数少(OR=1.03,95%CI 1.01~1.04)和罹患子宫内膜异位症(OR=0.68,95%CI 0.49~0.95)为<35岁女性影响卵母细胞冻融复苏的独立危险因素。而对于年龄≥35岁女性,基础雌二醇水平升高(OR=0.98,95%CI 0.98~0.99)、冻存时间延长(OR=0.98,95%CI 0.97~0.99)、罹患子宫内膜异位症(OR=0.15,95%CI 0.06~0.36)和继发不孕(OR=0.22,95%CI 0.13~0.37)为影响卵母细胞冻融复苏效果的独立危险因素。结论:年龄是影响人成熟卵母细胞解冻复苏效果的关键因素。不同年龄段女性,影响卵母细胞冻融复苏存活与否的因素不同。35岁之前,随着年龄的增长、窦卵泡数的减少和子宫内膜异位症的发生,卵母细胞解冻失败的风险明显增加。35岁之后,基础雌二醇水平升高、卵母细胞冻存时间延长和子宫内膜异位症等因素为卵母细胞解冻失败的关键危险因素。

Objective: To explore the influencing factors of the effect of oocyte resuscitation of mature oocytes cryopreservation in infertile women, and to provide evidences for clinical decision-making. Methods: The clinical data of 2691 mature oocytes from the women with infertile caused by their husbands were retrospectively analyzed. According to the survival situation after oocyte resuscitation, these cryopreservation oocytes were divided into 2003 survival oocytes and 688 non-survival oocytes. According to age, these oocytes of the women were divided 2297 oocytes of the women <35 years old and 394 oocytes of the women ≥35 years old. Univariate and multivariate logistic regression analysis were applied to explore the risk factors of affecting oocyte thawing. Results: The survival rate of cryopreservation oocytes after resuscitation was 74.4%(2003/2691). Advanced age(OR=0.94, 95%CI 0.91-0.97), less antral follicles(OR=1.03, 95%CI 1.01-1.04), and endometriosis(OR=0.68, 95%CI 0.49-0.95) were the independent risk factors affecting oocyte thawing of women under 35 years old. For women ≥35 years old, basal estradiol level(OR=0.98, 95%CI 0.98-0.99), prolonged cryopreservation time(OR=0.98, 95%CI 0.97-0.99), endometriosis(OR=0.15, 95%CI 0.06-0.36), and secondary infertility(OR=0.22, 95%CI 0.13-0.37) were the independent risk factors affecting oocyte thawing. Conclusion: Age is the key factor affecting the resuscitation of human mature oocytes after cryopreservation. The factors affecting the resuscitation of human mature oocytes after cryopreservation of the women with different ages are different.Before 35 years old,the risk of oocyte thawing failure of thewomen increased significantly with the increase of age,with the decrease of antral follicles,and with the occurrence of endometriosis.For women≥35 years old,elevated basal estradiol level,prolonged cryopreservation time,and endometriosis were the key risk factors for oocyte thawing failure.