子宫内膜异位症患者行体外受精治疗单个取卵周期累积活产率分析

Cumulative live birth rateof per oocyte retrieved cycle in Women with Endometriosis treated by In-vitro fertilization

目的分析子宫内膜异位症-不孕症患者行体外受精(IVF)治疗的单个取卵周期累积活产率。方法回顾性分析2014年1月—2020年9月在本院生殖医学科因子宫内膜异位症为不孕症主要指征进行IVF治疗的201对不育夫妇接受291个取卵周期的临床资料,分组情况为:(1)女方年龄分组:≤35岁组、35岁<~<40岁组、≥40岁组;(2)获卵数不同分组:1~3枚组,4~5枚组、6~10枚组、11~15枚组、≥16枚组;(3)按照腹腔镜/经腹手术史分为卵巢囊肿剔除组、手术未剔除卵巢囊肿组、未接受手术组。比较各组单个取卵周期累积临床妊娠率、累积自然流产率及累积活产率。结果291个取卵周期中16个周期(5.5%)未获卵,47个取卵周期(16.2%)未获得可利用胚胎。每取卵周期累积临床妊娠率为51.2%(149/291),累积自然流产率为22.1%(33/149),累积活产率为42.6%(124/291),其中8个周期为流产后再次移植同取卵周期剩余冷冻胚胎获得活产。(1)年龄分组比较:≥40岁组累积临床妊娠率(12.5%)均显著低于≤35岁组(58.0%)及35岁<~<40岁组(62.0%),差异有统计学意义;随着年龄的增加,累积自然流产率(12.5%、45.2%、83.3%)逐渐增加,累积活产率(53.4%、40.0%、2.1%)逐渐下降,差异有统计学意义。(2)获卵数分组比较:随着获卵数的增加,累积临床妊娠率(14.1%、61.0%、68.8%、78.7%、96.8%)及活产率(8.7%、53.7%、60.9%、63.8%、80.7%)均呈上升趋势;获卵数1~3枚组累积临床妊娠率、累积活产率均显著低于其他各组,差异有统计学意义。(3)手术剔除卵巢囊肿组累积临床妊娠率、累积活产率均显著低于手术未剔除卵巢囊肿组(43.6%、62.1%;36.1%、57.6%),差异均有统计学意义。(4)获卵数≤3枚时,曾接受卵巢囊肿剔除术的患者≤35岁组累积活产率为10.6%(5/47),>35岁组则为0(0/20)。结论子宫内膜异位症患者接受IVF助孕治疗累积活产率与女方年龄及获卵数呈相关性,卵巢子宫内膜异位囊肿剔除术导致的卵巢低反应会对IVF产生不良影响。

Objective To explore the cumulative live birth rate of per oocytes retrieved cycle in patients with Endometriosis-infertility treated by In-vitro fertilization(IVF).Methods To retrospectively analyze the clinical data of 201 infertile couples who received IVF treatment for endometriosis as the main indication of infertility in the Department of Reproductive Medicine of our hospital from Jan,2014 to Sep,2020.The participants were grouped in three ways:(1)groups by female age:≤35 years old,35<-<40 years old,≥40 years old;(2)groups by retrieved oocytes number:1-3,4-5,6-10,11-15,≥16;(3)groups by the history of laparoscopic/abdominal surgery:oophorocystectomy group,pelvic surgery without oophorocystectomy group,and no surgery group.The cumulative clinical pregnancy rate,cumulative miscarriage rate and cumulative live birth rate were compared among the groups.Results Among the 291 oocytes retrieved cycles,16 cycles(5.5%)did not obtain oocytes,47 cycles(16.2%)did not obtain available embryos.The cumulative clinical pregnancy rate,cumulative live birth rate,and cumulative miscarriage rate were 51.2%,42.6%and 22.1%,respectively.The results by female age showed that women aged≥40 years had significantly lower clinical pregnancy rate(12.5%)than women aged≤35 years(58.0%)and women aged 35<-<40 years(62.0%).With increasing age,the cumulative miscarriage rate gradually increased(12.5%,45.2%,83.3%),and cumulative live birth rate gradually decreased(53.4%,40.0%,2.1%).The results by retrieved oocytes number showed that as the retrieved oocytes number increasing(1-3,4-5,6-10,11-15,≥16),the cumulative pregnancy rate(14.1%,61.0%,68.8%,78.7%,96.8%)and the cumulative live birth rate(8.7%,53.7%,60.9%,63.8%,80.7%)gradually increased.Results by the history of laparoscopic/abdominal surgery showed that patients with oophorocystectomy had lower cumulative clinical pregnancy rate and live birth rate than those without oophorocystectomy but received surgery treatment previously(43.6%vs 62.1%,36.1%vs 57.6%).When the number of oocytes retrieved was≤3,the cumulative live birth rate was 10.6%in women aged≤35 years and 0 in women aged>35 years for patients who had oophorocystectomy history.Conclusion The cumulative live birth rate of patients with endometriosis receiving IVF treatment might be correlated with the age of the woman and the number of oocytes retrieved.The low ovarian response caused by oophorocystectomy might be associated with adverse effect of IVF.