胚胎移植12 491个周期的临床效果及影响因素分析

目的 探讨体外受精-胚胎移植(IVF-ET)治疗不孕的临床效果及其影响因素.方法 回顾性分析北京大学第三医院2005至2007年间,12 491个胚胎移植周期(其中6832个周期为新鲜胚胎移植周期,5659个周期为冻融胚胎移植周期)的临床资料,对影响妊娠结局的因素进行单因素和多因素分析.结果 新鲜胚胎移植周期临床妊娠率为32.99%(2254/6832),活产率为25.75%(1394/5413),早期流产率为9.36%(211/2254),围产儿出生缺陷率为1.45%(25/1722).年轻(20～24岁)患者新鲜胚胎移植周期临床妊娠率高达42.25%(60/142).单纯男方因素不孕患者的临床妊娠率(40.10%,476/1187)明显高于单纯女性因素不孕患者(31.55%,1168/3702)和双方因素不孕患者(31.39%,610/1943);首次接受IVF-ET治疗者的临床妊娠率(34.63%,1831/5287)高于多次接受IVF-ET治疗者;常用的4种IVF-ET超促排卵(COH)治疗方案中,接受促性腺激素释放激素激动剂(GnRH-a)超长方案和长方案治疗者临床妊娠率分别为51.72%(30/58)和36.88%(489/1326),明显高于GnRH-a短方案(32.05%,1703/5313)和促性腺激素释放激素拮抗剂(GnRH-ant)方案(22.12%,23/104),差异有统计学意义(P<0.05).多因素logistic分析证实,年龄、获卵数和COH治疗周期数对IVF-ET治疗后妊娠结局的影响有统计学意义,而年龄是最主要的影响因素.治疗过程中,中重度卵巢过度刺激综合征(OHSS)的发生率为3.68%(321/8720),异位妊娠率为6.12%(138/2254),早期流产率为9.36%(211/2254).冻融胚胎移植周期临床妊娠率(38.08%,2155/5659),高于新鲜胚胎移植周期(32.99%,2254/6832),两者比较,差异有统计学意义(P<0.001);多胎妊娠率为27.70%(597/2155),早期流产率为8.96%(193/2155),异位妊娠率为2.23%(48/2155).结论 IVF-ET用于不孕症治疗,临床妊娠率和活产率高,是一种安全、有效的助孕治疗方法;年龄、卵巢反应性是影响治疗结局的主要因素;冻融胚胎移植周期临床妊娠率与新鲜胚胎移植周期比较,无明显差异,并可有效提高单次促排卵周期的累计妊娠率.

Clinical analysis of 12 491 cycles treated in embryo transfer program

Objective To analyze the clinical outcomes of patients treated with in vitro fertilization and embryo transfer (IVF-ET) and influence factors of pregnancy rate. Methods We retrospectively analyzed the clinical data of 12 491 cycles, including 6832 fresh IVF/intracytoplast single sperm injection (ICSI) cycles and 5659 frozen embryo transfer (FET) cycles from 2005 to 2007. Results The clinical pregnancy rate per cycle was 32. 99% (2254/6832)in fresh embryo transfer program, and the live birth rate was 25.75% (1394/5413); the early pregnant loss rate was 9. 36% (211/2254), and the prenatal defect rate was 1.45% (25/1722). Through analysis of these patients' basic data, we found that the patients' age, causes for infertility, egg retrieval and cycle number affected the pregnancy rate. Using logistic regression method, we found that patients′ age was the most important factor affecting pregnancy outcome. In FET cycles, the clinical pregnancy rate was 38.08% (2155/5659), significantly higher than fresh embryo transfer cycles. Conclusions IVF-ET treatment is a safe and effective method for infertility couples. However, the female age and poor ovarian response are the main factors affecting pregnancy rate. Thawed embryo transfer can increase the accumulated pregnancy rate effectively.