拮抗剂方案新鲜周期胚胎移植影响因素分析

摘要

目的 探讨影响拮抗剂方案新鲜周期胚胎移植临床妊娠成功的因素.方法 对南京医科大学附属南京妇产医院 (原南京市妇幼保健院) 生殖医学中心2015年1至12月行拮抗剂方案体外受精/单精子胞浆内注射 (IVF/ICSI) 治疗并行新鲜周期胚胎移植的286例患者资料进行回顾性分析, 按是否临床妊娠分为未妊娠组和妊娠组, 比较两组间患者的治疗情况及效果, 并对P≤0.1组别进行非条件Logistic回归分析以排除混杂因素, 并对Logistic回归分析结果进一步细化分析.按患者年龄分为A组≤30岁, 30岁40岁, 分析各组间的治疗情况及效果.结果 身体质量指数 (BMI) 及年龄是影响临床妊娠率的两个相对独立的因素, 临床妊娠率与BMI指数 (偏回归系数=0.082, P=0.030) 及患者年龄 (偏回归系数=0.760, P=0.003) 均呈负相关.将患者按年龄分为A组≤30岁, 30岁40岁, 进一步进行细化分析, 不同年龄组别间患者不孕年限 (F=12.362, P<0.001) 、平均Gn用量 (F=4.454, P=0.004) 、平均移植胚胎数 (F=15.771, P<0.001) 及临床妊娠率 (χ2=7.704, P=0.043) 均有显著差别.结论 年龄、BMI指数是影响拮抗剂方案新鲜周期胚胎移植临床妊娠成功的关键因素.%Objective To investigate the influential factors of clinical pregnancy rate of women receiving fresh cycle embryos transfer by using antagonist protocol. Methods Retrospective analysis was performed on 286 patients undergoing antagonist protocol in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) treatment combining fresh cycle embryos transfer from January to December 2015 in Reproductive Medical Center of Obstetrics and Gynecology of Hospital Affiliated to Nanjing Medical University. According to whether clinical pregnancy occurred, patients were divided into non-pregnancy group and pregnancy group. Therapeutic conditions and efficacy were compared between two groups, and non-conditional Logistic regression analysis was conducted to exclude confounding factors in groups with P value being or less than 0.1. Patients were divided into group A (≤30 years) , group B (31-35 years) , group C (36-40 years) and group D (>40 years). Therapeutic conditions and efficacy were analyzed in each group. Results BMI and age were two independent factors affecting clinical pregnancy rate, and they were negativity related to pregnancy rate (partial regression coefficent was 0.082 and 0.760, P values was 0.03 and 0.003). There were significant differences among four groups in duration of infertility (F=12.362, P<0.001) , average amount of Gn (F=4.454, P=0.004) , average number of transfer embryos (F=15.771, P<0.001) and pregnancy rate (χ2=7.704, P=0.043).Conclusion Age and BMI are key factors of clinical pregnancy in women receiving GnRH antagonist protocol and fresh cycle embryo transfer.