常规方案促排卵周期获卵数≤3枚患者的临床结局分析

Analysis of clinical outcomes of patients with number of oocytes retrieved≤3 in conventional ovulation induction cycles

目的探讨常规方案促排卵周期获卵数≤3枚患者的临床结局及影响因素。方法采用回顾性队列研究,选取2012年1月至2017年1月期间在北京大学第三医院生殖医学中心接受体外受精-胚胎移植(in vitro fertilization and embryo transfer,IVF-ET)助孕、采用常规方案促排卵治疗获卵数≤3枚患者的临床资料,统计分析患者新鲜移植周期妊娠结局,并以临床妊娠为结局指标进行单因素和多因素分析,探讨影响患者临床妊娠结局的相关因素。结果常规方案促排卵周期获卵数≤3枚患者新鲜移植周期临床妊娠率为24.1%(503/2090),活产率为15.2%(318/2090)。以临床妊娠为结局指标进行单因素分析显示,获卵数(P=0.001)、是否预期卵巢低反应(poor ovarian response,POR)(P<0.001)、年龄(P<0.001)、窦卵泡计数(antral follicle count,AFC)(P<0.001)、不孕年限(P=0.008)、人绒毛膜促性腺激素(human chorionic hormone,hCG)注射日血清孕酮水平(P=0.001)、促排卵方案(P=0.003)、内膜厚度(P<0.001)、移植胚胎数(P<0.001)是影响患者临床妊娠结局的相关因素。进一步logistics回归分析显示,预期POR[OR(95%CI)=0.469(0.307~0.718)]、年龄[OR(95%CI)=0.929(0.905~0.954)]、hCG注射日血清孕酮水平[OR(95%CI)=0.891(0.808~0.984)]、内膜厚度[OR(95%CI)=1.084(1.015~1.157)]、移植胚胎数目[OR(95%CI)=1.678(1.389~2.026)]是患者临床妊娠结局的独立影响因素。结论在获卵数≤3枚患者中,高龄及预期POR及hCG注射日血清孕酮水平升高是影响患者临床妊娠结局的独立危险因素。

Objective To explore the influencing factors of clinical outcomes in patients with No.of oocytes retrieval≤3 in conventional ovulation induction cycles.Methods The infertility women who received in vitro fertilization and embryo transfer(IVF-ET)in the Center for Reproductive Medicine of Peking University Third Hospital from January 2012 to January 2017 were included in our retrospective cohort study.We analyzed the IVF outcomes of all the patients,as while univariate and multivariate analysis were conducted to explore the related factors influencing clinical pregnancy outcome.Results The clinical pregnancy rate and the live birth rate of the patients were respectively 24.1%(503/2090)and 15.2%(318/2090).Univariate analysis with clinical pregnancy as outcome index showed that the number of retrieved oocytes(P=0.001),expected poor ovarian response(POR)(P<0.001),age(P<0.001),antral follicle count(AFC)(P<0.001),infertility duration(P=0.008),progestrogen level on human chorionic hormone(hCG)injection day(P=0.001),ovulation induction protocol(P=0.003),endometrial thickness(P<0.001),and the number of transferred embryos(P<0.001)were the related factors affecting clinical pregnancy outcome.Further logistic regression analysis showed that expected POR[OR(95%CI)=0.469(0.307-0.718)],age[OR(95%CI)=0.929(0.905-0.954)],progestrogen level on hCG injection day[OR(95%CI)=0.891(0.808-0.984)],endometrial thickness[OR(95%CI)=1.084(1.015-1.157)]and the number of transferred embryos[OR(95%CI)=1.678(1.389-2.026)]were the independent influencing factors of clinical pregnancy outcome.Conclusion Elder age,expected POR and higher progestrogen level on hCG injection day are independent risk factors for clinical pregnancy outcome of patients with IVF-ET and the number of oocytes retrieved≤3.