年龄对卵巢低反应患者辅助生殖技术治疗后活产率的影响及其阈值效应分析

背景卵巢低反应（POR）患者较差的妊娠结局一直是生殖医学领域难题之一，但目前关于年龄对POR患者辅助生殖技术（ART）治疗后活产率的阈值效应的研究少见。目的分析年龄对POR患者ART治疗后活产率的影响及其阈值效应。方法商丘市第一人民医院妇产科和新疆医科大学第一附属医院生殖助孕中心2014年8月至2018年12月共收治接受常规体外授精/卵胞质内单精子注射-胚胎移植（IVF/ICSI）助孕治疗的女性共19 185例，选取其中诊断为POR者共3 337例为研究对象。所有患者采用控制性促排卵方案，同时采用IVF/ICSI进行胚胎移植并给予黄体支持治疗。分析所有患者活产婴儿情况，年龄对POR患者ART治疗后活产婴儿的影响采用单因素和多因素Logistic回归分析，并建立平滑拟合曲线、进行阈值效应分析。结果3 337例POR患者ART治疗后活产婴儿1 134例，未活产婴儿2 203例，活产率为33.98%（1 134/3 337）。多因素Logistic回归分析结果显示，年龄是POR患者ART治疗后活产婴儿的独立影响因素〔OR=0.920，95%CI（0.902，0.939），P<0.01〕。建立平滑拟合曲线发现，年龄与POR患者ART治疗后活产率呈负相关，但二者之间并非简单的线性关系；阈值效应分析结果显示，POR患者ART治疗后活产率下降的折点为32岁，即年龄≤32岁的POR患者ART治疗后活产率不受年龄影响〔OR=1.000，95%CI（0.998，1.012），P=0.38〕，但年龄>32岁的POR患者ART治疗后活产率随年龄增长而降低〔OR=0.800，95%CI（0.799，0.823），P<0.01〕。结论年龄是POR患者ART治疗后活产婴儿的独立影响因素，年龄>32岁的POR患者ART治疗后活产率随年龄增长而降低。

Threshold Effect Analysis of Influence of Age on Live Birth Rate in Poor Ovarian Response Patients Treated by Assisted Reproductive Technology

Background Pregnancy outcome in patients with poor ovarian response(POR)has always been one of the difficult problems in reproductive medicine,but there is few threshold effect analysis of influence of age on live birth rate in POR patients treated by assisted reproductive technology(ART).Objective To analyze the threshold effect of influence of age on live birth rate in POR patients treated by ART.Methods Among 19185 women who received routine in vitro fertilization/intracytoplasmic sperm injection(IVF/ICSI)and embryo transplantation in Department of Gynaecology and Obstetrics,the First People's Hospital of Shangqiu and Fertility Support Center,the First Affiliated Hospital of Xinjiang Medical University from August 2014 to December 2018,3337 patients with POR were selected,and received controlled ovarian stimulation,embryo transplantation by IVF/ICSI and luteal support therapy.The incidence of live birth was analyzed.Univariate and multivariate Logistic analyses were used to analyze the influence of age on live birth in POR patients treated by ART.Moreover,smooth curve fitting and threshold effect analysis were conducted.Results Of the 3337 cases,1134 obtained a live birth,the other 2203 did not,achieving a rate of live birth of 33.98%(1134/3337).Multivariate Logistic analysis result showed that,age was independently associated with live birth in POR patients treated by ART〔OR=0.920,95%CI(0.902,0.939),P<0.01〕.Smooth curve fitting showed that,age was negatively correlated with live birth rate in POR patients treated by ART,but the correlation was not simple linear.Threshold effect analysis results showed that,32 years old was the threshold for decrease of live birth rate in POR patients treated by ART,namely age did not affect the live birth rate in those≤32 years old〔OR=1.000,95%CI(0.998,1.012),P=0.38〕,but the live birth rate decreased as age grew in those over 32 years old〔OR=0.800,95%CI(0.799,0.823),P<0.01〕.Conclusion Age was an independent influencing factor of live birth in POR patients treated by ART.The live birth rate may decrease as age grows in these patients over 32 years old.