体外受精-胚胎移植失败的影响因素分析

目的:分析体外受精-胚胎移植失败的影响因素.方法:收集4 886例病人的病史资料,将1次助孕成功的1 420例作为A组,2次及以上助孕成功病人的324个成功周期作为B组,与之对应的365个失败周期作为C组,对可能引起体外受精-胚胎移植失败的相关因素进行分析.结果:A组年龄明显小于B组且不孕年限较B组短(P<0.01).辅助生殖技术治疗相关因素分析显示:A组较B组促排卵时更多采用长方案,B组较C组更多采用微刺激或者拮抗剂等方案,且B组采用卵母细胞单精子注射的比例也高于A组和C组(P<0.01).体外受精结果分析显示:相较于A组,B组移植胚胎数要更多,但取卵总数、受精率、优胚率、可用胚胎数、冷冻胚胎数、种植率均较低(P<0.01);而相较于C组,B组取卵总数、受精率、卵裂率、优胚率、移植胚胎数、可用胚胎数、冷冻胚胎数均较高(P<0.05~P<0.01).结论:年龄大、不孕时间长、获卵数少、可用胚胎数少、胚胎质量差的病人易发生体外受精-胚胎移植治疗失败,对于前一周期治疗失败的病人采用个性化治疗,改变促排方案或者受精方式等可能有助于提高其成功率.

The influencing factor analysis of in vitro fertilization and embryo transfer failure

Objective:To analyze the influencing factor of the in vitro fertilization and embryo transfer failure.Methods:The clinical data of 4 886 patients were collected.The patients with assisted pregnancy success at the first time(1 420 cases),324 success cycles and 365 failure cycles patients with assisted pregnancy success at two times and more than two times were divided into group A,B and C,respectively.The related factors of in vitro fertilization and embryo transfer failure were analyzed.Results:The age and infertile time in group A were significantly less and shorter than those in group B,respectively(P<0.01).The assisted reproductive technology(ART) results showed that long protocol in ovulation was often implemented in group A compared with group B,the mini-stimulation and antagonist protocol were often used in group B compared with group C,and the proportion of ICSI in group B was higher than that in group A and group C(P<0.01).The results of IVF also showed that the number of embryo transplantation in group B was more than that in group A,the total number of oocyte retrieval,fertilization rate,high quality embryo rate,number of available embryo,number of frozen embryo and implanting rate in group B were lower compared with group A(P<0.01),and the total number of oocyte retrieval,fertilization rate,cleavagerate rate,high quality embryo rate,number of available embryo,number of frozen embryo and implanting rate in group B were higher compared with group C(P<0.05 to P<0.01).Conclusions:The patients with older age,longer duration of infertility,less retrieved oocyte,less available embryo and poorer quality embryo are easy to lead to the in vitro fertilization and embryo transfer failure.