卵母细胞和女性年龄:卵巢低反应对IVF/ICSI单胚胎移植后妊娠丢失和围产期风险的影响

Maternal age and oocyte competency:impact of low response on pregnancy loss and perinatal risk after single embryo transfer for IVF/ICSI

目的评估卵巢低反应对不良妊娠结局和和产科风险的影响。方法回顾性分析2016年1月到2020年12月、女性年龄在22~42岁之间、于西北妇女儿童医院生殖医学中心第1次行IVF/ICSI助孕的新鲜周期移植单胚胎的患者资料。卵巢的反应性通过获卵数进行量化并分组:低反应(获卵1~3枚)、欠佳反应(获卵4~9枚)、正常反应(获卵≥10枚)。主要观察指标为妊娠丢失率和单胎活产的不良产科结局。结果在纳入的5950名女性中,299人(5.0%)表现为低反应,2011人(33.8%)表现为欠佳反应,3640人(61.2%)表现为正常反应。妊娠丢失率在卵巢低反应组为18.9%,欠佳反应组为19.3%,正常反应组为17.6%。与卵巢正常反应组相比,卵巢低反应组与欠佳反应组妊娠丢失风险并未增加[低反应组:a OR(95%CI)=0.96(0.60,1.54),P>0.05;欠佳反应组:a OR(95%CI)=1.06(0.89,1.26),P>0.05]。按年龄分层分析,年轻女性(<36岁)的妊娠丢失风险与卵巢反应性无关(P>0.05);但当女性年龄≥36岁时,卵巢低反应组及欠佳反应组的妊娠丢失风险显著增加[低反应组:a OR(95%CI)=4.76(1.51,14.99),P<0.05;欠佳反应组:a OR(95%CI)=2.13(1.07,4.22),P<0.05]。相比卵巢正常反应女性,卵巢低反应女性产科不良结局没有增加(P>0.05)。结论IVF/ICSI治疗中,高龄低反应患者妊娠丢失的潜在风险增加。

Objective:To evaluate the effect of the low response on the risk of adverse pregnancy and obstetrics outcomes.Methods:The clinical data of women aged 22-42 years old who underwent their first IVF/ICSI fresh transfer cycles with single-embryo transfer at reproductive medicine center of Northwest Women’s and Children’s Hospital from January 2016 to December 2020 were analyzed retrospectively.Ovarian response was quantified by the number of oocytes retrieved:poor response(1-3 oocytes),suboptimal response(4-9 oocytes)and normal response(≥10 oocytes).The main outcome measures were pregnancy loss rate and adverse obstetric outcomes of singleton live birth.Results:Among the 5950 women included,299(5.0%)showed poor response,2011(33.8%)suboptimal response and 3640(61.2%)normal response.The pregnancy loss rate was 18.9%in poor response group,19.3%in suboptimal response group,17.6%in normal response group.Compared with normal ovarian response,the risk of pregnancy loss was not significantly increased in the poor or suboptimal response group[poor response group:a OR(95%CI)=0.96(0.60,1.54),P>0.05;suboptimal response group:a OR(95%CI)=1.06(0.89,1.26),P>0.05].Stratified by age,the risk of pregnancy loss was not related to ovarian response in young women(<36 years old)(P>0.05).However,when women were≥36 years old,the risk of pregnancy loss was significantly increased in the poor response group or the suboptimal response group[poor response:a OR(95%CI)=4.76(1.51,14.99),P<0.05;suboptimal response:a OR(95%CI)=2.13(1.07,4.22),P<0.05].There was no increased risk of adverse obstetric outcomes in the women with poor response compared with normal responders(P>0.05).Conclusions:During IVF/ICSI treatment,the potential risk of pregnancy loss increases in elderly women with low response.