体质量指数对PCOS患者IVF/ICSI妊娠及围产结局的影响

Impact of body mass index on pregnancy outcomes and perinatal outcomes of PCOS patients undergoing IVF/ICSI

目的探讨体质量指数(BMI)对接受IVF/ICSI助孕治疗的多囊卵巢综合征(PCOS)患者妊娠期并发症及妊娠结局的影响。方法回顾性分析2019年1月至2021年12月于西北妇女儿童医院生殖中心行IVF/ICSI治疗的PCOS患者资料,共1143个周期,按照BMI值分为正常体重组(18.5 kg/m^(2)≤BMI<24 kg/m^(2),n=461)、超重组(24 kg/m^(2)≤BMI<28 kg/m^(2),n=433)、肥胖组(BMI≥28 kg/m^(2),n=249),比较3组患者的一般资料、妊娠期并发症及妊娠结局,并采用多因素Logistic回归分析年龄、不孕年限、不孕类型、促排卵方案、受精方式、移植胚胎个数及移植胚胎类型等与妊娠结局的关系。结果超重组和肥胖组的Gn起始量、Gn总量及Gn天数均显著高于正常体重组(P<0.05),2PN数、可用胚胎数、优胚数及囊胚形成率均显著低于正常体重组(P<0.05)。超重组的中重度OHSS发生率(1.73%)和肥胖组的中重度OHSS发生率(1.25%)均显著低于正常体重组(4.02%)。肥胖组的流产率(21.88%vs.13.31%)和妊娠期高血压疾病发生率(12.50%vs.4.33%)均显著高于正常体重组(P<0.05),超重组的活产率(57.97%)和肥胖组的活产率(50.20%)均显著低于正常体重组(60.74%)(P<0.05)。在校正年龄、不孕年限、移植胚胎个数及类型等相关混杂因素后,肥胖是[OR=0.67,95%CI(0.49,0.91),P=0.012]活产率下降的危险因素,而孕妇年龄[OR=0.96,95%CI(0.92,0.99),P=0.003]和移植D5囊胚[OR=1.40,95%CI(1.22,1.60),P<0.001]也是活产率的独立影响因素。结论在接受IVF/ICSI助孕治疗的PCOS女性中,BMI升高会导致促排卵用药时间更长,剂量更大,同时导致流产率及妊娠期高血压疾病发生率升高,活产率降低。因此建议拟行IVF/ICSI助孕治疗的肥胖PCOS患者减重,以改善妊娠结局和减少妊娠期并发症的发生。

Objective:To explore the impact of body mass index(BMI)on pregnancy complications and outcomes in patients with polycystic ovary syndrome receiving IVF/ICSI assisted pregnancy treatment.Methods:The data of PCOS patients who underwent IVF/ICSI treatment at the Reproductive Center of Northwest Women’s and Children’s Hospital from January 2019 to December 2021 were retrospective analyzed.A total of 1143 cycles were divided into normal weight group(18.5 kg/m^(2)≤BMI<24 kg/m^(2),n=461),overweight group(24 kg/m^(2)≤BMI<28 kg/m^(2),n=433),and obesity group(BMI≥28 kg/m^(2),n=249)based on BMI values.The general information,pregnancy complications,and pregnancy outcomes of the three groups of patients were compared.The multivariate logistic regression analysis was used to analyze the relationship between pregnancy outcomes and age,infertility years,infertility type,ovulation induction protocol,fertilization model,the number and type of embryos transferred.Results:The initial amount,total amount and days of gonadotropin(Gn)in the overweight group and obesity group were significantly higher than those in the normal weight group(P<0.05),while the number of 2PN,available embryos,excellent embryos and blastocyst formation rate were significantly lower than those in the normal weight group(P<0.05).The incidence of moderate to severe OHSS in the overweight group(1.73%)and the obesity group(1.25%)were significantly lower than those in the normal weight group(4.02%).The abortion rate(21.88%vs.13.31%)and the incidence of gestational hypertension(12.50%vs.4.33%)in the obesity group were significantly higher than those in the normal weight group(P<0.05).The live birth rate of overweight(57.97%)and obesity group(50.20%)were significantly lower than those of normal weight group(60.74%)(P<0.05).After adjusting for confounding factors such as age,infertility years,number and type of embryos transferred,obesity was the risk of a decrease in live birth rate[OR=0.67,95%CI(0.49,0.91),P=0.012].The age of pregnant women[OR=0.96,95%CI(0.92,0.99),P=0.003]and the transplantation of Day 5 blastocysts[OR=1.40,95%CI(1.22,1.60),P<0.001]were also independent influencing factors for live birth rate.Conclusions:In PCOS women receiving IVF/ICSI assisted pregnancy treatment,an increase in BMI can lead to longer duration and higher doses of ovulation induction medication.At the same time,it leads to an increase in the incidence of miscarriage and gestational hypertension,and a decrease in live birth rate.Therefore,it is recommended that obese PCOS patients undergoing IVF/ICSI assisted pregnancy therapy should lose weight to improve pregnancy outcomes and reduce the occurrence of pregnancy complications.