焦虑抑郁及生活事件对体外受精-胚胎移植受精率、优质胚胎及囊胚形成率的影响

The effects of anxiety,depression and life events on the fertilization rate,high quality embryo rate and blastocyst formation rate of patients underging IVF-ET

目的探讨焦虑、抑郁情绪及生活事件对体外受精-胚胎移植受精率、优质胚胎、囊胚形成率的影响。方法采用焦虑自评量表(self rating anxiety scale,SAS)、抑郁自评量表(self rating depression scale,SDS)、生活事件量表(life events scale,LES)对107例行体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)的女性患者进行测评,根据患者SAS、SDS评分是否正常分为3组,即SAS标准分<50分(无焦虑)且SDS标准分<53分(无抑郁)为正常组40例,SAS标准分≥50分(有焦虑)为焦虑组30例;SDS标准分≥53分(有抑郁)为抑郁组37例。根据LES评分分为3组,即第1组(<20分组)43例、第2组(20~32分组)35例及第3组(>32分组)29例。比较各组受精率(受精卵数/总卵数),优质胚胎形成率(优质胚胎数/2PN卵裂数),囊胚形成率(形成囊胚数/培养囊胚总数)的差异。结果焦虑组和抑郁组受精率、优质胚胎形成率、囊胚形成率均显著低于正常组,差异有统计学意义(P<0.01);焦虑组与抑郁组比较差异无统计学意义(P>0.05)。生活事件第1组受精率显著高于其他2组受精率(P<0.01),第2组与第3组受精率比较差异无统计学意义(P>0.05);3组优质胚胎形成率比较差异均有统计学意义(P<0.05);3组囊胚形成率差异均无统计学意义(P>0.05)。结论焦虑、抑郁情绪及过多的生活事件影响受精率、优质胚胎形成率、囊胚形成率,不利于妊娠成功,生殖医学科工作人员应该制定针对性的干预措施,调动可以影响患者情绪的各个支持系统,降低不良事件的刺激,提高受精率、优质胚胎形成率、囊胚形成率,改善治疗效果,努力改善妊娠结局。

Objective To investigate the effects of anxiety,depression and life events on the fertilization rate,high quality embryo rate and blastocyst formation rate of patients underging in-vitro fertilization-embryo transfer(IVF-ET).Methods The anxiety,depression and life events levels of 107 patients who underwent IVF-ET were assessed and analyzed by Self rating Anxiety Scale(SAS)and Self rating Depression Scale(SDS).According to the standard scores,the patients were divided into three groups,control group with SAS standard score<50(no anxiety)and SDS standard score<53(no depression),and anxiety group with SAS standard score≥50(with anxiety)and depression group with SDS standard score≥53(with depression).Moreover the patients were divided into the other three groups according to the LES scores,group1 with LES score<20,group 2 with LES score between 20 and 32,and group 3 with LES score>32.the fertilization rate(number of fertilized oocytes/total number of oocytes),high quality embryo rate(number of top quality embryos/number of normal fertilized embryos),and blastocyst formation rate(number of blastocysts/number of cultured embryos)were observed and compared among the groups.Results The fertilization rate,high quality embryo rate and blastocyst formation rate in anxiety group and depression group were significantly lower than those in control group(P<0.01),however there were no significant differences between anxiety group and depression group(P>0.05).Moreover the fertilization rate in group1 was significantly higher than that in the other two groups(P<0.01),whereas,there was no significant difference between group 2 and group 3(P>0.05).There was significant difference in high quality embryo rate among the three groups(P<0.05),however,there was no significant difference in blastocyst formation rate among the three groups(P>0.05).Conclusion The anxiety,depression and over-loaded life events can negatively affect the fertilization rate,high quality embryo rate as well as blastocyst formation rate,which are unfavourable to unsuccessful pregnancy.Thus,targeted intervention treatments should be formulated to mobilize each supporting system to reduce the adverse effects of events,improve fertilization rate,high quality embryo rate and blastocyst formation rate,so as to improve the pregnancy outcome.