影响高龄女性IVF-ET新鲜周期临床妊娠结局的多因素分析

目的探讨高龄患者体外受精-胚胎移植(IVF-ET)临床妊娠结局的影响因素。方法选取2017年1月至2018年12月于本院行IVF-ET治疗的年龄>35岁的患者968例为研究对象,所有患者均行新鲜周期胚胎移植,根据是否获得临床妊娠分为临床妊娠组(442例)及未妊娠组(526例)两组。回顾性分析患者的临床、实验室及随访资料,采用Logistic回归分析影响高龄女性临床妊娠结局的因素,并分年龄层(36～40岁和≥40岁)探讨影响不同年龄层高龄女性妊娠结局的可能因素。结果临床妊娠组的男、女双方年龄、基础FSH水平显著低于未妊娠组(P均<0.01),原发不孕、行第一周期IVF治疗、女方体重指数(BMI)、基础窦卵泡(AFC)数则显著高于未妊娠组(P均<0.05),长方案及超长方案比例、囊胚移植比例、HCG日内膜厚度亦显著高于未妊娠组(P均<0.05),Gn总剂量、HMG剂量、HCG日LH水平显著低于未妊娠组(P均<0.05);Gn应用时间、HCG日E2水平、获卵数显著高于未妊娠组(P均<0.01)。二元Logistic回归分析结果显示,IVF周期数(OR=0....

Multivariate analysis of clinical pregnancy outcomes of fresh IVF cycle in women with advanced age

Objective:To analyze the factors related to clinical pregnancy outcomes of IVF-ET in women with advanced age.Methods:The data of 968 women aged more than 35 years who underwent IVF-ET treatment with fresh embryo transfer in our medical center from January 2017 to December 2018 were collected.The patients were divided into two groups according to the clinical pregnancy result:clinical pregnancy group(n=442)and non-pregnancy group(n=526).The clinical,laboratory and follow-up data of patients were retrospectively analyzed.The factors related to pregnancy outcomes were analyzed by univariate and logistic regression methods.And the women were subdivided to 36-40 years old group and≥40 years old group to explore the possible factors that affect the pregnancy outcomes of elderly women of different ages.Results:The female age,male age and basal FSH in clinical pregnancy group were significantly lower than non-pregnancy group(P<0.01).The proportion of primary infertility and the ratio of the first cycle IVF,body mass index(BMI),basal antral follicle count(AFC)in clinical pregnancy group were significantly higher than non-pregnancy group(P<0.05).The proportion of using long and super-long protocol,blastocyst transfer ratio and endometrial thickness on HCG day in the clinical pregnancy group were significantly higher than those in the non-pregnancy group(P<0.05).The total doses of Gn and HMG,LH on HCG day in clinical pregnancy group significantly lower than non-pregnancy group(P<0.05).The duration of Gn used,estrodiol(E2)on HCG day and number of oocytes retrieved in clinical pregnancy group significantly higher than non-pregnancy group(P<0.05).The logistic regression analysis suggested that number of IVF cycles(OR=0.712,P=0.036),female age(OR=0.362,P=0.000),basal FSH(OR=0.960,P=0.030),basal AFC(OR=1.041,P=0.028),endometrial thickness on HCG day(OR=1.084,P=0.008)and number of retrieved oocytes(OR=1.085,P=0.001)were the independent influencing factors on the clinical pregnancy outcome in IVF-ET cycle in women with advanced age.Further stratified logistic regression analysis showed that female age(OR=0.848,P=0.029),basal AFC(OR=1.050,P=0.005),number of embryos transfer(OR=1.809,P=0.001),blastocyst transfer(OR=1.866,P=0.001)were independent factor for women aged 36-40 years old.The female age(OR=0.765,P=0.003),basal FSH(OR=0.891,P=0.007),basal AFC(OR=1.109,P=0.006)were independent factors for women aged≥40 years old.Conclusions:For infertility women with advanced age,IVF-ET should be chosen as soon as possible to treat infertility.According to different ages,the ovulation induction protocol can be adjusted to obtain the maximum number of oocytes retrieved,choosing the appropriate endometrial thickness&number of embryo transfers and blastocysts transfer,in order to improve the clinical pregnancy rate.