超长方案常规体外受精多精受精发生的影响因素分析

Influencing factors of polyspermy during conventional in vitro fertilization in super-long protocol

目的探讨超长方案常规体外受精(in vitro fertilization,IVF)多精受精发生的影响因素。方法本研究为回顾性病例对照分析。选择2018年10月至2021年8月期间在山西省运城市中心医院生殖医学科采用超长方案行常规IVF的316例患者,按照本周期多精受精的发生与否分成正常受精组和多精受精组。分别统计两组患者的一般情况和临床助孕情况。将单因素分析中P<0.15的相关因素纳入logistic回归模型进行多因素分析。结果316个IVF周期的多精受精周期发生率为71.84%(227/316)。正常受精组和多精受精组的女方年龄、不孕年限、原发不孕占比、不孕因素、体质量指数(body mass index,BMI)、基础卵泡刺激素(follicle-stimulating hormone,FSH)水平和基础抗苗勒管激素(anti-Müllerian hormone,AMH)水平差异均无统计学意义(均P>0.05)。正常受精组和多精受精组的促性腺激素(gonadotropin,Gn)启动剂量、Gn总剂量、Gn使用时间和人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)注射日孕酮差异均无统计学意义(均P>0.05);多精受精组直径≥14 mm的卵泡数[(13.66±4.51)个]、hCG注射日雌二醇[17247.49±9450.74)pmol/L]和获卵数[(17.48±7.37)个]明显高于正常受精组[(11.78±3.54)个,P<0.001;(14135.29±7369.84)pmol/L,P=0.002;(13.01±6.17)个,P<0.001];多精受精组的hCG注射日黄体生成素(luteinizing hormone,LH)水平[(0.79±0.51)U/L]明显低于正常受精组[(1.02±0.78)U/L,P=0.014]。logistic回归结果显示:直径≥14 mm卵泡数、hCG注射日雌二醇和hCG注射日孕酮未能进入回归方程(分别为OR=1.063、OR=1.676和OR=1.078,均P>0.05);hCG注射日LH和获卵数与多精受精的发生相关(分别为OR=1.900,P=0.028和OR=2.539,P=0.003)。结论超长方案常规IVF多精受精周期发生率偏高;与其多精受精的发生有显著相关性的指标有直径≥14 mm卵泡数、hCG注射日雌二醇、hCG注射日LH和获卵数;hCG注射日LH偏低和获卵数较多是超长方案常规IVF多精受精发生的独立危险因素,其中获卵数对多精受精发生的影响最大。

Objective To investigate influencing factors of polyspermy during conventional in vitro fertilization(IVF)in super-long protocol.Methods This study was a retrospective case-control analysis.From October 2018 to August 2021,316 patients who underwent conventional IVF using super-long protocol in the Department of Reproductive Medicine,Yuncheng Central Hospital of Shanxi Province were selected and divided into normal fertilization group and polyspermy fertilization group according to polyspermy fertilization incidence in this cycle.The general data and clinical assisted pregnancy data in the two groups were analyzed.The correlation factors of P<0.15 in the single factor analysis were included in logistic regression model for multivariate analysis.Results There were 227 polyspermy fertilization cycles out of 316 IVF cycles,and the incidence of polyspermy fertilization was 71.84%.There were no significant differences in female age,infertility duration,primary infertility ratio,infertility factors,body mass index(BMI),basal follicle-stimulating hormone(FSH)level and basal anti-Müllerian hormone(AMH)level between normal fertilization group and polyspermy fertilization group(all P>0.05).There were no significant differences in gonadotropin(Gn)initiation dosage,total dosage and duration of Gn used,and progesterone(P)on human chorionic gonadotropin(hCG)injection day between normal fertilization group and polyspermy fertilization group(all P>0.05).The number of follicles with a diameter of≥14 mm,estradiol(E2)on hCG injection day and the number of retrieved oocytes in polyspermy fertilization group were significantly higher than those in normal fertilization group[13.66±4.51 vs.11.78±3.54,P<0.001;(17247.49±9450.74)pmol/L vs.(14135.29±7369.84)pmol/L,P=0.002;17.48±7.37 vs.13.01±6.17,P<0.001].Luteinizing hormone(LH)level on hCG injection day in polyspermy fertilization group was significantly lower than that in normal fertilization group[(0.79±0.51)U/L vs.(1.02±0.78)U/L,P=0.014].Logistic regression results showed that the number of follicles with a diameter of≥14 mm,E2 and P level on hCG injection day could not enter the regression equation(OR=1.063,OR=1.676 and OR=1.078,respectively,all P>0.05);LH level on hCG injection day and the number of retrieved oocytes were correlated with polyspermy(OR=1.900,P=0.028;OR=2.539,P=0.003).Conclusion The incidence of polyspermy fertilization cycle during conventional IVF in super-long protocol was high.The number of follicles with a diameter of≥14 mm,E2 and LH levels on hCG injection day and the number of retrieved oocytes were significantly correlated with the occurrence of polyspermy.Lower LH level on hCG injection day and larger number of retrieved oocytes were independent risk factors of conventional IVF polyspermy fertilization in super-long protocol,and the number of retrieved oocytes had the greater influence on polyspermy fertilization.