目的:研究体外受精-胚胎移植(IVF-ET)多次助孕周期妊娠结局的变化趋势,探讨影响重复周期妊娠结局的相关因素.方法:回顾性分析中山大学孙逸仙纪念医院生殖中心2008年1月—2009年10月行IVF/胞浆内单精子注射(ICSI)助孕治疗的患者1314例(1 746周期),其中助孕周期次数≥3的患者128例(191周期).分析妊娠结局与助孕周期次数的关系,比较第3周期未妊娠者(A组,68例)与妊娠者(B组,37例)既往未妊娠周期中相关指标的差异.结果:临床妊娠率、活产率在第1～4周期间呈现递减趋势(P＜0.001),第1周期临床妊娠率显著高于第2周期,活产率显著高于第2～4周期,但第2周期及其后周期间临床妊娠率、活产率差异无统计学意义(P＞0.05).Logistic回归分析第1/2周期中有统计学意义的变量为年龄、不孕类型和优质胚胎个数,其OR值分别为0.757/0.865、12.00/3.376和1.711/1.436.结论:IVF-ET第1周期临床妊娠率和活产率高,其后周期临床妊娠率、活产率与周期次数无明显关系.在第1、2周期未妊娠的患者中,年龄越小、优质胚胎数越多和继发不孕者在第3周期中获得妊娠的可能性越大.%Objective:To study the pregnancy and delivery rates of repeated IVF-ET cycles,and explore factors associated with pregnant outcome of repeated cycles. Methods:1 746 cycles of oocyte retrieval (128 repeated cycles) were retrospectively analyzed in our reproductive center from 2008.1 to 2009.10. Among the women who had no pregnancy in cycle 1 and cycle 2,there are 68 patients were still not pregnant in cycle 3 (group A) ,and 37 patients got pregnancy in cycle 3 (group B). The factors of cycle 1 and cycle 2 were compared between group A and group B. Results: Clinical pregnancy and live-birth rates for cycle 1,2,3,4 and ≥5 were 35.5% and 34.3% ,25.6% and 22.7% ,23.4% and 14.0% , 15.0% and 12.5% ,22.7% and 15.0% respectively (P<0.001). The clinical pregnancy rates decreased significantly from cycle 1 to cycle 2(P<0.05) ,and the live-birth rates decreased significantly from cycle 1 to cycle 2,3 and 4(P<0.05) ,but there was no significant decline in clinical pregnancy and live-birth rates within cycle 2,3,4 and ≥5. It is shown in logistic model that age, primary or secondary infertility, and number of good quality embryo are significant in both cycle 1 and cycle 2. Conclusions: The outcome of the first IVF-ET cycle is better than followed cycles, but the clinical pregnancy and live-birth rates of following IVF-ET cycles were similar. Among patients who did not get pregnancy in cycle 1 and 2, younger, secondary infertility women with more good quality embryos may more likely achieve a desired outcome in cycle 3.
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