卵泡输出率结合体重指数对辅助生殖患者助孕结局的预测作用

摘要

目的 探讨卵泡输出率(FORT)结合体重指数(BMI)在评价辅助生殖患者助孕结局中的预测作用. 方法 回顾性分析郑州大学第一附属医院生殖医学中心2013年1月至2014年12月行IVF-ET治疗患者的4 865个周期病历资料,根据妊娠结局分为妊娠组与未妊娠组,对比两组的年龄、不孕年限、BMI、基础FSH/LH比值、FORT、窦卵泡数(AFC)、Gn天数、Gn总量、成熟卵泡数(PFC)、获卵数、2PN受精率、优质胚胎率、移植胚胎数、胚胎总数等指标;再按照FORT分为低、中、高三组,对比各组各项指标,对BMI与FORT线性相关性进行分析. 结果 妊娠组与未妊娠组比较,妊娠组的Gn总量显著低于未妊娠组[(2 155.39±890.62)IU vs.(2 400.22±1 049.87)IU](P＜0.05),而其AFC、PFC、FORT、获卵数、胚胎总数、优质胚胎率均显著高于未妊娠组(P＜0.05);FORT低、中、高分组对比中,AFC、Gn总量随FORT值升高而显著降低(P＜0.05);PFC、获卵数、胚胎总数随FORT值升高而显著升高(P＜0.05);优质胚胎率在高、中、低FORT组分别为70.81％、67.20％和67.21％,差异有统计学意义(P＜0.05);临床妊娠率在高、中、低FORT组分别为55.20％、54.25％和49.22％,差异有统计学意义(P＜0.05);超重组和正常BMI组相比,正常BMI组的Gn天数、Gn总量显著低于超重组(P＜0.05);正常BMI组的获卵数、胚胎总数、临床妊娠率均高于超重组(P＜0.05);FORT和BMI之间不存在线性相关关系. 结论 FORT值可以对辅助生殖患者卵巢反应性、胚胎发育潜能起到预测作用;超重患者控制BMI至正常水平,可有效改善IVF/ICSI妊娠结局.%Objective:To investigate the predictive value of follicular output rate(FORT) and BMI on assisted reproduction outcome.Methods:The data of 4 865 patients undergone IVF-ET treatment in the First Affiliated Hospital of Zhengzhou University from January 2013 to December 2014 were retrospectively analyzed.The patients were divided into two groups according to pregnancy.The age,duration of infertility,BMI,basic FSH/LH ratio,FORT,number of antral follicles (AFC),days and dosage of gonadotropin (Gn) used,preovulatory follicle count(PFC),number of oocytes retrieved,2PN fertilization rate,high quality embryos rate,number of embryos transferred,number of embryos implantation,and total number of embryos were compared between the two groups.The patients were also divided to three groups according to FORT index(low/ medium/high) and the clinical and laboratory parameters were compared.The correlation between BMI and FORT was also tested.Results:The total dosage of Gn in pregnancy group was significantly lower than no-pregnancy group [(2 155.39 ± 890.62) IU vs.(2 400.22 ± 1 049.87) IU] (P＜0.05),but AFC,PFC,FORT,number of oocytes retrieved,total number of embryos,and the quality embryos rate were significantly higher than those in no-pregnancy group(P＜0.05).The total number of AFC and total dosage of Gn used were significantly decreased (P ＜ 0.05),but the numbers of PFC,oocytes retrieved and embryos significantly increased along with the increase of FORT among the low/medium/high FORT groups(P＜0.05).The high quality embryos rate in high FORT group was significantly less than that in the medium FORT or low group(70.81％ vs.67.20％,70.81％ vs.67.21％)(P＜0.05).Clinical pregnancy rate of low FORT group was less than the high or medium FORTgroup(49.22％ vs.54.25 ％,49.22 ％ vs.55.20％)(P＜0.05).The days and total dosage of Gn used in normal BMI group were significant lower than those in over BMI group(P＜0.05).The number of oocytes retrieved,total embryos,and clinical pregnancy rate in normal BMI group were significantly higher than over BMI group (P＜0.05).There was no linear correction between the FORT and the BMI.Conclusions:FORT index can predict ovarian response,embryonic development potential in assisted reproductive patients.Controlled BMI to normal level can improve the IVF/ICSI pregnancy outcome in overweight patients.