CAJ | 학술논문

目的：比较再生育继发不孕妇女行体外受精—胚胎移植（IVF－ET）后不同临床妊娠结局的影响因素，评估各影响因素对临床妊娠结局的相对重要性，为妇女再生育指导提供科学依据。方法：回顾性分析2012年7月至2014年7月浙江大学医学院附属妇产科医院因再生育继发不孕行IVF－ET的1099例妇女1129个IVF－ET治疗周期的临床、实验室及随访资料。按是否临床妊娠分为两组，通过单因素分析和二元logistic回归分析研究再生育继发不孕妇女行IVF－ET治疗临床妊娠结局的影响因素；比较各年龄阶段不同胚胎移植数的临床妊娠结局；并分析比较促性腺激素释放激素（ GnRH ）激动剂长方案、GnRH激动剂短方案、GnRH拮抗剂方案等3种常用控制性超促排卵（ COH ）方案治疗≥40岁高龄再生育继发不孕妇女的助孕效果。结果：1129个治疗周期中临床妊娠376例次（33．30％），未临床妊娠753例次（66．70％），这两组女方年龄、女方体质量指数、基础卵泡刺激素、窦卵泡数、移植胚胎数和男方年龄差异有统计学意义（均P＜0．05）。二元logistic回归分析发现年龄（ OR ＝0．900，95％CI：0．873～0．928， P ＜0．001）、移植胚胎数（ OR＝2．248，95％CI：1．906～2．652， P＜0．001）是再生育继发不孕妇女行IVF－ET治疗临床妊娠是否成功的独立影响因素。30～40岁移植双胚胎与＜30岁移植多胚胎妇女的临床妊娠率差异无统计学意义（ P＞0．05）。年龄≥40岁再生育继发不孕妇女应用GnRH激动剂长方案、GnRH激动剂短方案和GnRH拮抗剂方案三组妇女临床妊娠率差异无统计学意义（ P＞0．05）。结论：年龄和胚胎移植数是预测再生育继发不孕妇女行IVF－ET治疗临床妊娠结局的独立影响因素。30～40岁妇女建议移植胚胎数不超过2个。年龄≥40岁再生育继发不孕妇女的临床妊娠率显著降低，应用GnRH激动剂长方案、GnRH激动剂短方案、GnRH拮抗剂方案对其临床妊娠率无明显影响。目的：比較再生育繼髮不孕婦女行體外受精—胚胎移植（IVF－ET）後不同臨床妊娠結跼的影響因素，評估各影響因素對臨床妊娠結跼的相對重要性，為婦女再生育指導提供科學依據。方法：迴顧性分析2012年7月至2014年7月浙江大學醫學院附屬婦產科醫院因再生育繼髮不孕行IVF－ET的1099例婦女1129箇IVF－ET治療週期的臨床、實驗室及隨訪資料。按是否臨床妊娠分為兩組，通過單因素分析和二元logistic迴歸分析研究再生育繼髮不孕婦女行IVF－ET治療臨床妊娠結跼的影響因素；比較各年齡階段不同胚胎移植數的臨床妊娠結跼；併分析比較促性腺激素釋放激素（ GnRH ）激動劑長方案、GnRH激動劑短方案、GnRH拮抗劑方案等3種常用控製性超促排卵（ COH ）方案治療≥40歲高齡再生育繼髮不孕婦女的助孕效果。結果：1129箇治療週期中臨床妊娠376例次（33．30％），未臨床妊娠753例次（66．70％），這兩組女方年齡、女方體質量指數、基礎卵泡刺激素、竇卵泡數、移植胚胎數和男方年齡差異有統計學意義（均P＜0．05）。二元logistic迴歸分析髮現年齡（ OR ＝0．900，95％CI：0．873～0．928， P ＜0．001）、移植胚胎數（ OR＝2．248，95％CI：1．906～2．652， P＜0．001）是再生育繼髮不孕婦女行IVF－ET治療臨床妊娠是否成功的獨立影響因素。30～40歲移植雙胚胎與＜30歲移植多胚胎婦女的臨床妊娠率差異無統計學意義（ P＞0．05）。年齡≥40歲再生育繼髮不孕婦女應用GnRH激動劑長方案、GnRH激動劑短方案和GnRH拮抗劑方案三組婦女臨床妊娠率差異無統計學意義（ P＞0．05）。結論：年齡和胚胎移植數是預測再生育繼髮不孕婦女行IVF－ET治療臨床妊娠結跼的獨立影響因素。30～40歲婦女建議移植胚胎數不超過2箇。年齡≥40歲再生育繼髮不孕婦女的臨床妊娠率顯著降低，應用GnRH激動劑長方案、GnRH激動劑短方案、GnRH拮抗劑方案對其臨床妊娠率無明顯影響。
목적：비교재생육계발불잉부녀행체외수정—배태이식（IVF－ET）후불동림상임신결국적영향인소，평고각영향인소대림상임신결국적상대중요성，위부녀재생육지도제공과학의거。방법：회고성분석2012년7월지2014년7월절강대학의학원부속부산과의원인재생육계발불잉행IVF－ET적1099례부녀1129개IVF－ET치료주기적림상、실험실급수방자료。안시부림상임신분위량조，통과단인소분석화이원logistic회귀분석연구재생육계발불잉부녀행IVF－ET치료림상임신결국적영향인소；비교각년령계단불동배태이식수적림상임신결국；병분석비교촉성선격소석방격소（ GnRH ）격동제장방안、GnRH격동제단방안、GnRH길항제방안등3충상용공제성초촉배란（ COH ）방안치료≥40세고령재생육계발불잉부녀적조잉효과。결과：1129개치료주기중림상임신376례차（33．30％），미림상임신753례차（66．70％），저량조녀방년령、녀방체질량지수、기출란포자격소、두란포수、이식배태수화남방년령차이유통계학의의（균P＜0．05）。이원logistic회귀분석발현년령（ OR ＝0．900，95％CI：0．873～0．928， P ＜0．001）、이식배태수（ OR＝2．248，95％CI：1．906～2．652， P＜0．001）시재생육계발불잉부녀행IVF－ET치료림상임신시부성공적독립영향인소。30～40세이식쌍배태여＜30세이식다배태부녀적림상임신솔차이무통계학의의（ P＞0．05）。년령≥40세재생육계발불잉부녀응용GnRH격동제장방안、GnRH격동제단방안화GnRH길항제방안삼조부녀림상임신솔차이무통계학의의（ P＞0．05）。결론：년령화배태이식수시예측재생육계발불잉부녀행IVF－ET치료림상임신결국적독립영향인소。30～40세부녀건의이식배태수불초과2개。년령≥40세재생육계발불잉부녀적림상임신솔현저강저，응용GnRH격동제장방안、GnRH격동제단방안、GnRH길항제방안대기림상임신솔무명현영향。
Objective: To investigate the factors related to clinical pregnancy outcomes of in vitor fertilization-embryo transfer ( IVF-ET )in women with secondary infertility .Methods:The clinical , laboratory and follow-up data of 1129 cycles in 1099 patients with secondary infertility undergoing IVF-ET in Women’s Hospital, Zhejiang University School of Medicine between July 2012 to July 2014 were retrospectively reviewed.The factors related to pregnancy outcomes were analyzed by univariate and logistic regression methods .The clinical pregnancy rates in women with different age and different number of embryos transferred were compared .The clinical outcomes of stimulation with gonadotropin releasing hormone ( GnRH ) agonist long protocol , GnRH agonist short protocol and GnRH antagonist protocol were evaluated in secondary infertile patients aged≥40 years.Results: Among 1129 cycles, 376 cases( 333.0 %) had clinical pregnancy and 753 cases(66.70%)had no clinical pregnancy.There were significant differences in age , body mass index , basal follicle-stimulating hormone level , antral follicle number , paternal age and number of embryos transferred between pregnancy and no pregnancy groups(P<0.05);while only maternal age(OR=0.900, 95%CI:0 .873 ~0 .928 , P <0 .001 )and the number of embryos transferred (O R =2.248,95%CI:1.906~2.652,P<0.001)were the independent factors affecting the clinical pregnancy outcome of IVF-ET.There was no significant difference in clinical pregnancy rate between women aged 30 ~40 years with two embryos transferred and those aged<30 years with two or three embryos transferred ( P>0.05 ) .There were no significances in clinical pregnancy rate among women aged ≥40 years using GnRH agonist long protocol , GnRH agonist short protocol and GnRH antagonist protocol for stimulation(P>0.05).Conclusion: Maternal age and number of embryos transferred have independent effect on IVF-ET clinical pregnancy outcome of secondary infertile women.We suggest that no more than two embryos should be transferred for women in their thirties to minimize the risk of multiple pregnancy while still having an acceptable pregnancy rate .The pregnancy rate of patients over 40 years decreases significantly , and there is no difference in pregnancy rate by using GnRH agonist long protocol ,GnRH agonist short protocol or GnRH antagonist protocol .