反复控制性超促排卵对胚胎发育及妊娠结局的影响

Effect of repeated controlled ovarian hyperstimulation on embryonic development and pregnancy outcomes

目的探讨反复控制性超促排卵(COH)对胚胎发育潜能及妊娠结局的影响。方法回顾性分析2014年1月至2020年7月于河南省人民医院生殖医学中心接受体外受精-胚胎移植(IVF-ET)助孕治疗的7086例患者的临床资料,根据COH次数将患者分为A组(首次行COH者)、B组(第2次行COH者)、C组(第3次或第4次行COH者),比较3组患者的胚胎发育指标(卵子成熟率、正常受精率、正常卵裂率、可利用胚胎率)和妊娠结局(胚胎种植率、生化妊娠率、临床妊娠率、异位妊娠率、流产率、早期流产率)。结果3组患者的卵子成熟率、正常受精率随COH次数的增加有下降趋势,但差异无统计学意义(P>0.05)。A组患者的正常卵裂率和可利用胚胎率均高于B组和C组(P<0.05);B组与C组患者的正常卵裂率、可利用胚胎率比较差异无统计学意义(P>0.05)。A组患者的胚胎种植率、生化妊娠率、临床妊娠率均显著高于B组和C组(P<0.05);B组与C组患者的胚胎种植率、生化妊娠率、临床妊娠率比较差异无统计学意义(P>0.05)。3组患者异位妊娠率比较差异无统计学意义(P>0.05)。B组患者的流产率和早期流产率高于A组(P<0.05);其余各组患者的流产率和早期流产率比较差异均无统计学意义(P>0.05)。结论反复COH可能会在一定程度上降低IVF-ET周期患者的正常卵裂率、可利用胚胎率、胚胎种植率、生化妊娠率、临床妊娠率及流产率。

Objective To investigate the effect of repeated controlled ovarian hyperstimulation(COH)on the embryonic development potential and pregnancy outcomes.Methods The clinical data of 7086 patients who received in vitro fertilization-embryo transfer(IVF-ET)assisted pregnancy treatment in the Reproductive Medical Center of Henan Provincial People′s Hospital from January 2014 to July 2020 were analyzed retrospectively.According to the times of COH,the patients were divided into group A(the first time for ovulation induction),group B(the second time for ovulation induction)and group C(the third time and more than three times of ovulation induction).The embryo development indexes(oocyte maturation rate,normal fertilization rate,normal cleavage rate and available embryo rate)and pregnancy outcomes(embryo implantation rate,biochemical pregnancy rate,clinical pregnancy rate,ectopic pregnancy rate,abortion rate and early abortion rate)of patients were compared among the three groups.Results The oocyte maturation rate and normal fertilization rate decreased with the increase of COH times in the three groups,but the difference was not statistically significant(P>0.05).The normal cleavage rate and available embryonic rate of patients in the group A were significantly higher than those in the group B and group C(P<0.05);there was no significant difference in the normal cleavage rate and available embryonic rate of patients between the group B and group C(P>0.05).The embryo implantation rate,biochemical pregnancy rate and clinical pregnancy rate of patients in the group A were significantly higher than those in the group B and group C(P<0.05);there was no significant difference in the embryo implantation rate,biochemical pregnancy rate and clinical pregnancy rate of patients between the group B and group C(P>0.05).There was no significant difference in the ectopic pregnancy rate among the three groups(P>0.05).The abortion rate and early abortion rate of patients in the group B were significantly higher than those in the group A(P<0.05);there was no significant difference in the abortion rate and early abortion rate among other groups(P>0.05).Conclusion Repeated COH may reduce the normal cleavage rate,available embryonic rate,embryo implantation rate,biochemical pregnancy rate,clinical pregnancy rate and miscarriage rate of patients in IVF-ET cycles to some extent.