剖宫产史对IVF/ICSI-ET治疗累积活产率的影响

Effect of Cesarean Section History on Cumulative Live Birth Rate Following IVF/ICSI-ET

目的:比较既往剖宫产患者与既往阴道分娩患者接受体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)治疗首个取卵周期的临床结局。方法:回顾性分析2015年1月—2020年12月在天津市中心妇产科医院生殖医学中心行首次IVF/ICSI-ET治疗且既往有1次分娩史的患者既往剖宫产史对一次取卵周期累积活产率(cumulative live birth rate,CLBR)的影响。结果:共纳入1216例患者,其中既往剖宫产者605例共1053个移植周期,既往阴道分娩者611例共947个移植周期。2组患者除基础泌乳素与不孕时间外的主要基本特征、促排卵治疗方案、获卵情况、胚胎实验室结局差异均无统计学意义(均P>0.05)。既往剖宫产组单胚胎移植周期、冻融胚胎移植周期比例更高(P<0.05)。既往剖宫产组一次取卵后CLBR为59.00%(95%CI:55.08%~62.92%),既往阴道分娩组一次取卵后CLBR为62.68%(95%CI:58.84%~66.51%),2组比较差异有统计学意义(χ^(2)=13.665,P<0.001)。校正年龄、获卵数、胚胎质量及子宫内膜厚度后,与既往阴道分娩患者相比,既往剖宫产患者一次取卵后CLBR的OR值为0.825(95%CI:0.712~0.956,χ^(2)=6.531,P=0.011)。结论:与既往阴道分娩患者相比,既往剖宫产患者接受IVF/ICSI-ET治疗后,一次取卵周期的CLBR更低。

Objective:To investigate whether a previous caesarean section affects the clinical outcomes of patients undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)for the first oocyte retrieval cycle.Methods:This was a retrospective cohort study among women with one previous delivery history and undergoing IVF/ICSI-ET for the first-time treatment during January 2015 to December 2020 at the reproductive medicine center of Tianjin Central Hospital of Gynecology Obstetrics.All subjects were followed to the first delivery after ET,use-up of all embryos,drop-out or the end of the study period.We retrospectively analyzed the association between previous caesarean section and the cumulative live birth rate(CLBR).Results:A total of 1216 women were included,including 605 with a history of caesarean section and 611 with a history of vaginal delivery.Women with a previous caesarean section went through 1053 ET cycles,and women with a previous virginal delivery went through 947 ET cycles.No significant differences were observed in the baseline characteristics(except for prolactin and infertility time),clinical features of the treatment,number of oocytes retrieved and laboratory outcomes between the two groups(all P>0.05).Women with previous caesarean section history had higher proportions of single-embryo ET cycles and FET cycles(P<0.05).The CLBR among women with a previous caesarean section was 59.00%(95%CI:55.08%-62.92%),and the CLBR among women with a previous vaginal delivery was 62.68%(95%CI:58.84%-66.51%),the difference between the two groups was significant(χ^(2)=13.665,P<0.001).For the women with a previous caesarean section compared to women with a previous vaginal delivery,the OR of CLBR after adjusting for age,number of oocytes retrieved,quality of embryos and the endometrium thickness was 0.825(95%CI:0.712-0.956,χ^(2)=6.531,P=0.011).Conclusions:Compared to women with a previous vaginal delivery,women with a previous caesarean section had lower CLBR following IVF/ICSI-ET.