IVF-ET新鲜周期移植不孕而冷冻周期妊娠的相关因素分析

目的探讨IVF-ET助孕治疗中新鲜周期移植不孕而后续的冷冻周期成功妊娠的原因以指导治疗。方法回顾性分析体外受精或单精子卵母细胞浆内注射-胚胎移植术（IVF/ICSI-ET）治疗患者950个周期,其中新鲜周期妊娠组780个周期和新鲜周期未孕冷冻周期妊娠组170个周期,比较两组患者年龄、不孕年限、病因及基础FSH水平、Gn使用情况、hCG日内膜、激素水平、卵泡数、获卵及胚胎情况的差异。采用单因素分析筛选出差异有统计学意义的因素进行多因素分析。结果经Logistic回归分析得出hCG日P4、hCG日E2/1000是妊娠的独立影响因素。hCG日P4（OR=1.653,P=0.015,95%CI：1.101～2.482）,hCG日E2/1000（OR=1.219,P=0.001,95%CI：1.085～1.369）。hCG日酮孕每增加1ng/ml,新鲜周期不孕而冷冻周期妊娠的风险将增加1.653倍。hCG日E2每增加1000pg/ml,新鲜周期不孕而冷冻周期妊娠的风险将增加1.219倍。结论 hCG日的P4和E2是导致新鲜移植不孕而冷冻周期妊娠的重要原因。P4和E2过高,可考虑放弃新鲜移植,采用冷冻移植。

Analysis of the factors affecting the pregnancy outcome of frozen embryo transfers after fresh embryo transfer failure

Objective To investigate the factors affecting the pregnancy outcome of frozen embryo transfers after fresh embryo transfer failure. Methods The clinical records of the patients receiving IVF / ICSI-ET treatment with a total of 950 cycles , were retrospectively analyzed on age, duration of infertility, cause of disease, ovarian reserve, Gn usage, serum hormone levels and endometrial situation on the day of administration of hCG , oocyte and embryo quality. Statistical analysis of univariate and multiple logistic regressions were carried out for analysis. Results Serum E 2 / 1 000 （Statistical analysis of univariate and multiple logistic regressions）and P 4 （OR=1.653, P=0.015,with the 95% confidence interval 1.101～2.482） on the day of hCG injection were the independent influential factors in FET pregnancy cycles in fresh cycles. For the serum progesterone on the day of hCG injection, every increase of 1 ng/ml, the risk of fresh cycle failed but frozen cycle pregnancy increased 1.653 times. For the serum estrogen on the day of hCG injection , every increase of 1 000 pg/ml, the risk of fresh cycle failed but frozen cycle pregnancy increased 1.219 times. Conclusion Elevated progesterone and estradiol on the day of hCG injection were important reasons lead to the trend of fresh cycle failed but frozen cycle pregnancy. High progesterone and estradiol concentrations had a potential negative effect. For these patients , FET should be suggested to improve the pregnancy outcomes.