不孕症患者IVF-ET助孕后自然流产的相关因素分析

Analysis of factors associated with spontaneous miscarriage after IVF-ET in infertile patients

目的分析不孕症患者IVF-ET助孕后自然流产的相关因素。方法回顾性分析2022年7月至2023年6月在中国医学科学院北京协和医院首次接受IVF-ET助孕并临床妊娠的357例不孕症患者的临床资料,按照是否出现自然流产情况分为未流产组(n=312)和流产组(n=45),比较两组患者的基础临床资料、男方精液参数、疾病史/既往史、IVF-ET相关资料等临床资料,基于Logistic回归模型分析自然流产的相关因素。结果应用Logistic回归模型分析发现,年龄≥35岁、体质量指数(BMI)>24 kg/m^(2)、男方精子活力为D级、男方精子浓度≤15×10^(6)/ml、男方精子DNA碎片指数>20%、人工流产史>3次、自然流产史>3次、宫腔操作史>2次、有子宫肌瘤患病史、移植胚胎质量为C级是不孕症患者IVF-ET后自然流产的危险因素(OR>1,P<0.05)。结论不孕症患者的年龄大、BMI高、人工/自然流产次数多、宫腔操作次数多、有子宫肌瘤患病史和移植胚胎质量差可增加IVF-ET助孕后自然流产的风险,且男方精子活力差、浓度低和男方精子DNA碎片指数大也会加大IVF-ET后自然流产的风险。

Objective:To analyze the factors associated with spontaneous miscarriage after IVF-ET in infertility patients.Methods:A retrospective analysis was conducted on the clinical data of 357 infertile patients who received IVF-ET for the first time at Peking Union Medical College Hospital from July 2022 to June 2023.The patients were divided into the group without miscarriage(n=312)and the group with miscarriage(n=45)according to the occurrence of spontaneous miscarriage or not,and the clinical data of the two groups such as the general characteristics,male semen parameters,the present and history diseases,and IVF-ET related data were compared.Logistic regression model was employed to analyze the factors related to spontaneous miscarriage after IVF-ET in the infertility patients.Results:The results of Logistic regression model analysis found that not less than 35 years of age,>24 kg/m^(2) of body mass index(BMI),male sperm viability of grade D,≤15×10^(6)/ml of male sperm concentration,>20%of male sperm DNA fragmentation index,history of more than three induced abortions,history of more than three spontaneous abortions,history of more than two uterine manipulations,history of uterine fibroids,and grade C embryos transferred were risk factors for spontaneous miscarriage after IVF-ET in infertile patients(OR>1,P<0.05).Conclusions:Advanced age,higher BMI,more induced/spontaneous abortions,more uterine operations,history of uterine fibroids,and poor quality of transferred embryos of an infertile patient and poor sperm viability,low sperm concentration,and a high index of DNA fragmentation of the sperm of her husband could increase the risk of spontaneous miscarriage after IVF-ET.