月经周期规律性对超重/肥胖患者常规体外受精中卵巢反应性及早期胚胎发育的影响

Influence of menstrual cycle regularity on ovarian response and early embryonic development in conventional IVF among overweight/obese patients

目的探讨月经周期规律性对超重/肥胖患者常规体外受精(IVF)中卵巢反应性及早期胚胎发育的影响。方法回顾性分析2021年1月至2023年8月期间于武汉大学人民医院生殖医学中心行第1周期IVF助孕夫妇的临床资料,共1397个周期。根据女方体质量指数(BMI)分为正常BMI组(A组,18.5 kg/m^(2)≤BMI≤23.9 kg/m^(2),n=975)和超重及肥胖组(B组,BMI≥24 kg/m^(2),n=422);再根据患者月经周期是否规律,将B组进一步分为规律组(B1组,21 d≤月经周期≤35 d,n=251)和不规律组(B2组,月经周期<21 d和/或月经周期>35 d,n=171)。分析各组间促排卵过程中卵巢反应性和早期胚胎发育结局的差异。结果(1)A组和B组间年龄、不孕类型、抗苗勒管激素(AMH)水平比较均无统计学差异(P>0.05),B组患者不孕年限、月经周期天数、窦卵泡数(AFC)均显著高于A组(P<0.05),而基础性激素水平[雌二醇(E_(2))、孕酮(P)、黄体生成素(LH)、卵泡刺激素(FSH)]显著低于A组(P<0.05),两组患者间不孕原因整体比较有统计学差异(P<0.05)。相较于A组,B组促性腺激素(Gn)启动剂量和总剂量显著增加、Gn总天数显著增长(P<0.05);而两组患者间促排卵方案、获卵数和早期胚胎发育指标比较均无统计学差异(P>0.05)。(2)与B1组患者比较,B2组患者年龄显著减少,BMI、不孕年限及月经周期天数显著增加(P<0.05);两组患者间AFC、AMH水平、基础性激素水平(LH、FSH、P)及不孕原因整体比较均有统计学差异(P<0.05)。两组患者间促排卵方案整体比较有统计学差异(P<0.05),B2组采用拮抗剂方案促排卵比例较高;B2组Gn启动剂量和总剂量显著减少,获卵总数显著增多(P<0.05)。B2组D3优质胚胎率显著低于B1组(P<0.05),其余早期胚胎发育指标两组间比较均无统计学差异(P>0.05)。结论超重/肥胖女性卵巢反应性降低,但对IVF早期胚胎发育没有显著影响;月经周期不规律的超重/肥胖患者卵巢反应性相对升高,可对IVF周期D3优质胚胎的发育产生不利影响。

Objective:To investigate the effect of menstrual cycle regularity on ovarian response and early embryonic development in conventional IVF among overweight and obese patients.Methods:A retrospective study was conducted to analyze the data of couples who underwent the first cycle of conventional IVF in Renmin Hospital of Wuhan University from January 2021 to August 2023.According to the body mass index(BMI),the patients were divided into normal BMI group(group A,18.5 kg/m^(2)≤BMI≤23.9 kg/m^(2),n=975)and overweight/obesity group(group B,BMI≥24 kg/m^(2),n=422).According to the regularity of menstrual cycle,the patients in group B were further divided into regular menstrual cycle group(group B1,21 d≤menstrual cycle≤35 d,n=251)and irregular group(group B2,menstrual cycle<21 d and/or menstrual cycle>35 d,n=171).Results:There were no significant differences in age,type of infertility and anti-Müllerian hormone(AMH)level between group A and group B(P>0.05).The years of infertility,menstrual cycle,and antral follicle count(AFC)in group B were significantly higher than those in group A,while the levels of basic sex hormones regarding estradiol(E_(2)),LH,FSH,progesterone(P)were significantly lower than those in group A(P<0.05).There was a significant difference in the cause of infertility between the two groups(P<0.05).Compared with group A,the initiation and total gonadotropin(Gn)doses and the total days of Gn use in group B were significantly higher(P<0.05).There were no significant differences in the treatment protocol,the number of oocytes retrieved and early embryonic development between the two groups(P>0.05).Furthermore,compared with patients in group B1,patients in group B2 were significantly younger,and higher BMI as well as longer infertility years and menstrual cycle days were found(P<0.05).There were significant differences in AFC,levels of AMH and basic sex hormones(LH,FSH,P)and the cause of infertility between the two groups(P<0.05).There was significant difference in the treatment protocol between the two groups(P<0.05),and the percentage of antagonist protocol use was higher in group B2.The rate of D3 high-quality embryo of group B2 was significantly lower than that of group B1(P<0.05).And there were no significant differences in other indicators of early embryo development.Conclusions:The ovarian responsiveness of overweight/obese women decreased and had no effect on early embryonic development in IVF,while the ovarian responsiveness of overweight/obese patients with irregular menstrual cycle relatively increased,which had an adverse effect on the development of D3 high-quality embryo during IVF.