体外受精-胚胎移植后早期妊娠丢失的相关风险因素分析

目的：分析体外受精-胚胎移植（IVF-ET）后早期自然妊娠丢失及其相关因素。方法：收集2001年5月—2007年12月在中山大学孙逸仙纪念医院生殖中心行IVF-ET治疗获得妊娠的患者547例，根据其妊娠12周时情况分为妊娠丢失组和妊娠持续组，回顾性比较分析2组患者中女方的一般情况、不孕病因；男方的精液检查情况、精子来源和助孕过程。结果：本中心新鲜IVF/胞浆内单精子注射（ICSI）-ET周期的早期妊娠丢失率为26.87%，临床流产率为16.45%。547例患者中女方年龄≥37岁患者的早期妊娠丢失率为46.7%，显著高于≤30岁的患者（27.2%）及30～37岁的患者（21.7%，均P＜0.05）；单孕囊组妊娠丢失率为35.0%，显著高于多孕囊组的10.9%（P＜0.001）。多因素Logistic回归分析显示辅助生殖治疗后早期妊娠丢失相关风险因素依次为：多囊卵巢综合征（PCOS）排卵障碍（OR=7.025，95%CI为2.426～20.341）、女方年龄（OR=1.080，95%CI为1.006～1.160）、孕囊数（OR=0.042，95%CI为0.022～0.081）、人绒毛膜促性腺激素（hCG）注射日子宫内膜厚度（OR=0.904，95%CI为0.808～1.012）。结论：新鲜IVF/ICSI-ET周期的早期妊娠丢失率与自然妊娠流产率相似，早期妊娠丢失与PCOS患者的排卵障碍、女方年龄、着床孕囊数相关，高危患者在进行辅助生殖治疗前应积极治疗，尽早采取安胎措施减少妊娠丢失。

Risk Factors of Early Pregnancy Loss in IVF/ICSI-ET

Objective：To investigate the rate and correlation risk factors of early pregnancy loss in IVF/ICSI-ET. Methods：Calculated the IVF/ICSI-ET patients between May 2001 to December 2007，five hundred forty-seven cases with pregnancy were enrolled in this study, then divided into pregnancy loss group and ongoing pregnancy group. Their age，weight，pregnancy history，ARTs program，endocrine hormone on Day 3，ignition day，hCG administration day，oocyte retrieval day，and ET day were compared. The etiology of infertility，evaluation of sperm，echo patten and thickness of endometrium on hCG administration day， number of retrieved oocytes and embryo for cryopreservation， score of ET embryo，Serum β-hCG level，number of gestational sac on sonography were analyzed，risk factors were evaluated statistically. Results：The rate of early pregnancy loss in IVF/ICSI-ET is 26.87%，the clinical abortion rate is 16.45%. Anovulation of PCOS，the female age，the number of gestational sac on sonography，have significant difference between pregnancy loss group and ongoing group. Conclusions：The rate of early pregnancy loss in IVF/ICSI-ET is similar with the spontaneous abortion of natural pregnancy. The risk factors of early pregnancy loss in IVF/ICSI-ET may be related with the anovulation of PCOS，women′s age，the number of gestational sac in uterus 4-6 weeks following embryo transfer.