新鲜周期胚胎移植治疗原发性与继发性不孕症的妊娠结局差异及影响因素分析

Pregnancy outcomes and influencing factors of fresh embryo transfer cycle for primary and secondary infertility

目的 分析原发性与继发性不孕症患者新鲜周期胚胎移植的妊娠结局及影响因素。方法 收集行新鲜周期胚胎移植的不孕症患者资料,按照不孕类型分为原发性不孕症组和继发性不孕症组,比较2组临床资料、不孕因素、妊娠结局,应用多因素Logistic回归分析不同妊娠结局的影响因素。结果 原发性不孕症组的临床妊娠率、活产发生率均高于继发性不孕症组(P均<0.05)。女方年龄、不孕年限、获卵数、优质胚胎数、子宫内膜厚度为临床妊娠的影响因素(P <0.05)。对于临床妊娠结局,未校正任何临床特征,原发性不孕相对继发性不孕的临床妊娠OR值为1.34(1.14~1.59),P <0.001;校正男女双方及胚胎因素后,原发性不孕相对继发性不孕的临床妊娠OR值为1.25(1.02~1.53),P=0.032。对于活产结局,未校正任何因素情况下,原发性不孕相对继发性不孕的活产OR值为1.48(1.08~2.13),P=0.014;校正男女方、胚胎因素,原发性不孕相对继发性不孕的活产OR值为1.27 (0.86~1.88),P=0.237。结论 新鲜周期胚胎移植中,原发性不孕症较继发性不孕症能获得更好的妊娠结局。

Objective To analyze the pregnancy outcomes and influencing factors of fresh embryo transfer cycle in patients with primary and secondary infertility.Methods Clinical data of infertility patients who underwent fresh embryo transfer cycle were collected.All patients were divided into the primary and secondary infertility groups according to the type of infertility.Clinical data,infertility factors and pregnancy outcomes were statistically compared between two groups.The influencing factors of different pregnancy outcomes were identified by logistic regression analysis.Results The clinical pregnancy and live birth rates in the primary infertility group were higher than those in the secondary infertility group(both P<0.05).There was no statistical difference in the incidence of spontaneous abortion.Maternal age,duration of infertility,number of oocytes retrieved,number of high-quality embryos and endometrial thickness were correlated with clinical pregnancy(all P<0.05).For clinical pregnancy outcomes,without adjusting for any clinical characteristics,the odds ratio(OR)for clinical pregnancy between primary and secondary infertility was 1.34(1.14-1.59,P<0.001).After adjusting for male and female factors as well as embryo factors,the OR for clinical pregnancy between primary and secondary infertility was 1.25(1.02-1.53,P=0.032).For live birth outcomes,without adjusting for any factors,the OR for live birth between primary and secondary infertility was 1.48(1.08-2.13,P=0.014).After adjusting for male and female factors as well as embryo factors,the OR for live birth between primary and secondary infertility was 1.27(0.86-1.88,P=0.237).Conclusion In the fresh embryo transfer cycle,higher clinical pregnancy and live birth rates can be obtained in primary infertility patients compared with their counterparts with secondary infertility.