中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2011年
3期
161-165
,共5页
方春霞%李豫峰%章汉旺%靳镭%艾继辉%赖巧红
方春霞%李豫峰%章漢旺%靳鐳%艾繼輝%賴巧紅
방춘하%리예봉%장한왕%근뢰%애계휘%뢰교홍
流产,自然%生殖技术,辅助
流產,自然%生殖技術,輔助
유산,자연%생식기술,보조
Abortion,spontaneous%Reproductive techniques,assisted
目的 探讨辅助生殖技术(assisted reproductive technology,ART)助孕后单胎妊娠发生早期自然流产的相关因素.方法 对2003年1月1日至2008年8月31日在本院生殖中心行常规体外受精/卵母细胞浆内单精子注射的新鲜胚胎移植周期治疗后的1636例单胎妊娠病例进行分析,除外失访、子宫畸形、赠卵、晚期流产及资料不齐全者后,分为早期流产组(n=196)和活产分娩组 (n=1195),分析早期流产的相关因素.同时,比较新鲜胚胎移植周期和冷冻胚胎复苏移植周期(n=386)的流产率.结果 多因素Logistic回归分析早期自然流产的危险因素是孕妇年龄(OR=1.143,95%CI:1.096～1.196)、多囊卵巢综合征因素不孕(OR=4.309,95%CI:2.564～7.243),保护因素是移植胚胎的平均评分(OR=0.808,95%CI:0.717～0.912)、人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)注射日子宫内膜三线型(OR=0.431,95%CI:0.243～0.764).早期流产组和活产分娩组孕妇的年龄[(32.22±4.10)岁和(30.28±3.66)岁]、不孕年限[(5.90±4.26)年和(5.20±3.32)年]、基础卵泡刺激素水平[(6.35±2.30)mIU/ml和(5.95±2.12)mIU/ml]、移植胚胎数[(2.31±0.51)个和(2.18±0.49)个]、hCG注射日雌二醇水平[(2467.1±1588.8)pg/ml和(2934.5±1785.2)pg/ml]、胚胎平均评分(7.03±1.35和7.74±1.25)比较,差异均有统计学意义(P＜0.05),冷冻胚胎复苏移植周期流产率高于新鲜周期[17.36%(67/386)和13.02%(213/1636),χ2=4.296,P=0.023].结论 年龄大、不孕年限长、基础卵泡刺激素高、多囊卵巢综合征因素不孕、移植胚胎的平均评分低、hCG注射日子宫内膜非三线型的妇女ART妊娠后易发生早期流产.冷冻胚胎复苏移植周期的早期自然流产率高于新鲜胚胎移植周期.
目的 探討輔助生殖技術(assisted reproductive technology,ART)助孕後單胎妊娠髮生早期自然流產的相關因素.方法 對2003年1月1日至2008年8月31日在本院生殖中心行常規體外受精/卵母細胞漿內單精子註射的新鮮胚胎移植週期治療後的1636例單胎妊娠病例進行分析,除外失訪、子宮畸形、贈卵、晚期流產及資料不齊全者後,分為早期流產組(n=196)和活產分娩組 (n=1195),分析早期流產的相關因素.同時,比較新鮮胚胎移植週期和冷凍胚胎複囌移植週期(n=386)的流產率.結果 多因素Logistic迴歸分析早期自然流產的危險因素是孕婦年齡(OR=1.143,95%CI:1.096～1.196)、多囊卵巢綜閤徵因素不孕(OR=4.309,95%CI:2.564～7.243),保護因素是移植胚胎的平均評分(OR=0.808,95%CI:0.717～0.912)、人絨毛膜促性腺激素(human chorionic gonadotropin,hCG)註射日子宮內膜三線型(OR=0.431,95%CI:0.243～0.764).早期流產組和活產分娩組孕婦的年齡[(32.22±4.10)歲和(30.28±3.66)歲]、不孕年限[(5.90±4.26)年和(5.20±3.32)年]、基礎卵泡刺激素水平[(6.35±2.30)mIU/ml和(5.95±2.12)mIU/ml]、移植胚胎數[(2.31±0.51)箇和(2.18±0.49)箇]、hCG註射日雌二醇水平[(2467.1±1588.8)pg/ml和(2934.5±1785.2)pg/ml]、胚胎平均評分(7.03±1.35和7.74±1.25)比較,差異均有統計學意義(P＜0.05),冷凍胚胎複囌移植週期流產率高于新鮮週期[17.36%(67/386)和13.02%(213/1636),χ2=4.296,P=0.023].結論 年齡大、不孕年限長、基礎卵泡刺激素高、多囊卵巢綜閤徵因素不孕、移植胚胎的平均評分低、hCG註射日子宮內膜非三線型的婦女ART妊娠後易髮生早期流產.冷凍胚胎複囌移植週期的早期自然流產率高于新鮮胚胎移植週期.
목적 탐토보조생식기술(assisted reproductive technology,ART)조잉후단태임신발생조기자연유산적상관인소.방법 대2003년1월1일지2008년8월31일재본원생식중심행상규체외수정/란모세포장내단정자주사적신선배태이식주기치료후적1636례단태임신병례진행분석,제외실방、자궁기형、증란、만기유산급자료불제전자후,분위조기유산조(n=196)화활산분면조 (n=1195),분석조기유산적상관인소.동시,비교신선배태이식주기화냉동배태복소이식주기(n=386)적유산솔.결과 다인소Logistic회귀분석조기자연유산적위험인소시잉부년령(OR=1.143,95%CI:1.096～1.196)、다낭란소종합정인소불잉(OR=4.309,95%CI:2.564～7.243),보호인소시이식배태적평균평분(OR=0.808,95%CI:0.717～0.912)、인융모막촉성선격소(human chorionic gonadotropin,hCG)주사일자궁내막삼선형(OR=0.431,95%CI:0.243～0.764).조기유산조화활산분면조잉부적년령[(32.22±4.10)세화(30.28±3.66)세]、불잉년한[(5.90±4.26)년화(5.20±3.32)년]、기출란포자격소수평[(6.35±2.30)mIU/ml화(5.95±2.12)mIU/ml]、이식배태수[(2.31±0.51)개화(2.18±0.49)개]、hCG주사일자이순수평[(2467.1±1588.8)pg/ml화(2934.5±1785.2)pg/ml]、배태평균평분(7.03±1.35화7.74±1.25)비교,차이균유통계학의의(P＜0.05),냉동배태복소이식주기유산솔고우신선주기[17.36%(67/386)화13.02%(213/1636),χ2=4.296,P=0.023].결론 년령대、불잉년한장、기출란포자격소고、다낭란소종합정인소불잉、이식배태적평균평분저、hCG주사일자궁내막비삼선형적부녀ART임신후역발생조기유산.냉동배태복소이식주기적조기자연유산솔고우신선배태이식주기.
Objective To investigate the relative risk factors for early abortion among singleton pregnancies after assisted reproductive technology (ART) treatment. Methods A retrospective analysis was performed on 1636 singleton pregnancies, including 196 early abortion cases and 1195pregnancies with live birth after exclusion of those lost cases during follow-up, or complicated with uterine deformity, or oocyte receptor, or late abortion, or incomplete medical record, following in vitro fertilization(IVF)/ intracytoplasmic sperm injection (ICSI) treatment and the risk factors of early abortion were investigated. The early abortion rate was also compared between fresh IVF/ICSI group and frozen embryo transfer (FET) group (n=386). Results Multivariate Logistic regression analysis indicated that elder women (OR= 1. 143,95%CI: 1. 096-1. 196) and patients with polycystic ovarian syndrome (OR = 4. 309,95 % CI : 2. 564-7.243) were risk factors of spontaneous early abortion,and high mean score of transferred embryos (MSTE) (OR = 0. 808, 95% CI: 0. 717-0. 912) and endometrial triple-lined pattern on the day of human chorionic gonadotropin (hCG) administration (OR=0. 431, 95% CI: 0. 243-0.764)were protective factors. Significant difference were found in the maternal age [(32.22±4. 10) yrs vs (30.28±3. 66) yrs],the duration of infertility [(5. 90±4.26) yrs vs (5.20 ± 3. 32) yrs], basal serum follicle-stimulating hormone (FSH) level [(6. 35 ±2.30) mIU/ml vs (5.95±2.12) mIU/ml], number of transferred embryos (2. 31±0. 51) vs (2. 18±0.49), serum estradiol level on the day of hCG administration [(2467. 1 ± 1588. 8) pg/ml vs (2934. 5 ±1785.2) pg/ml] and MSTE (7.03 ±1.35 vs 7.74 ± 1.25) between the abortion group and livebirth group (all P＜0. 05). The spontaneous abortion rate was higher in the FET group than in the fresh embryo transfer group [17. 36%(67/386) vs 13.02% (213/1636), χ2 =4. 296, P=0. 023].Conclusions Women at elder age, or with long duration of infertility, high basal FSH level,polycystic ovarian syndrome, low MSTE, non-triple-lined pattern of endometrium on the day of hCG administration are at risk of spontaneous early abortion in pregnancies after ART. The rate of spontaneous abortion is higher in FET group than in fresh IVF/ICSI group.
