卵巢型子宫内膜异位症患者行IVF/ICSI后的妊娠结局及影响因素分析

Analysis of pregnancy outcomes and influencing factors in patients with ovarian endometriosis undergoing in vitro fertilization/intracytoplasmic sperm injection

目的 探讨卵巢型子宫内膜异位症(EMs)不孕患者行体外受精-卵胞质内单精子注射(IVF/ICSI)治疗后的妊娠结局,并分析其影响因素。方法 选取2012年1月至2022年3月于金华市人民医院生殖医学中心第一次行IVF/ICSI治疗的391例EMs不孕患者作为研究对象,其中卵巢型EMs 224例纳入卵巢型EMs组,非卵巢型EMs 167例纳入非卵巢型EMs组。比较两组妊娠结局,分析影响卵巢型EMs不孕患者妊娠结局的相关因素。结果 卵巢型EMs组基础卵泡刺激素(bFSH)水平、促性腺激素(Gn)用量高于非卵巢型EMs组,而获卵数、有效胚胎数低于非卵巢型EMs组(P<0.05);但两组妊娠结局无统计学差异(P>0.05)。卵巢型EMs组妊娠者Gn天数、获卵数、MⅡ数、正常受精数、优质胚胎数、有效胚胎数均高于未妊娠者(P<0.05)。Logistic回归分析显示,Gn天数、优质胚胎数是影响卵巢型EMs不孕患者行IVF/ICSI后妊娠结局的独立保护因素。结论 卵巢型EMs与非卵巢型EMs相比,卵巢储备能力下降,但两者IVF/ICSI治疗后的妊娠结局并无差异;提高卵巢储备能力,适当地延长Gn天数及增加优质胚胎数可使卵巢型EMs不孕患者获得更好的妊娠结局。

Objective To explore the pregnancy outcomes of infertile patients with ovarian endometriosis(EMs)treated with in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)and analyze the influencing factors.Methods A total of 391 infertile patients with EMs who underwent IVF/ICSI treatment for the first time at the Center of Reproductive Medicine of Jinhua People′s Hospital from January 2012 to March 2022 were selected as the study subjects.Among them,224 patients with ovarian EMs were selected as ovarian EMs group,and 167 patients with non⁃ovarian EMs were selected as non⁃ovarian EMs group.The pregnancy outcomes of two groups were compared and the relevant factors that affect the pregnancy outcomes of ovarian EMs infertility patients were analyzed.Results The basal follicle stimulating hormone(bFSH)level and gonadotropin(Gn)dosage in the ovarian EMs group were higher than those in the non⁃ovarian EMs group,while the number of oocytes obtained and viable embryos were lower than those in the non⁃ovarian EMs group(P<0.05).However,there was no difference in pregnancy outcomes between the two group(P>0.05).The Gn duration and number of oocytes obtained,MⅡoocytes,normal fertilization embryos,high⁃quality embryos and viable embryos in ovarian EMs pregnancy group were higher than those of the non⁃pregnancy group(P<0.05).Logistic regression analysis indicated that Gn duration and the number of high⁃quality embryos were the independent protective factors affecting the pregnancy outcomes of ovarian EMs infertility patients undergoing IVF/ICSI.Conclusions Compared with non⁃ovarian EMs group,ovarian reserve is reduced in the ovarian EMs group,but there is no difference in pregnancy outcomes between the two groups after IVF/ICSI treatment.Improving ovarian reserve,appropriately prolonging Gn duration and increasing the number of high⁃quality embryos can help ovarian EMs infertility patients achieve better pregnancy outcomes.