体重指数对体外受精-胚胎移植结局的影响

目的探讨体重指数（BMI）对体外受精-胚胎移植（IVF—ET）和卵胞浆内单精子注射（ICSI）结局的影响。方法选择2006年6月至2010年6月间在我院接受IVF-ET／ICSI治疗、年龄〈35岁的不育患者为对象，共449个周期。按BMI分为三组：低体重组（A组），BMI（18．5kg／m^2，共45个周期；正常体重组（B组）；18．5kg／m^2≤BMI〈25kg／m^2，共356个周期）、超重组（C组），BMI≥25kg／m^2，共48个周期。比较三组的促性腺激素（Gn）使用天数及用量、人绒毛膜促性腺激素（hCG）注射日内膜厚度及血清雌二醇（E2）水平、获卵数、受精率、卵裂率、优胚率、胚胎着床率、临床妊娠率及早期流产率。结果C组Gn用量显著高于A和B组（P〈0．05），hCG日血清E2水平显著低于A、B组（P〈0．05），早期流产率显著高于B组（P〈0．05）；三组获卵数、受精率、卵裂率、优胚率、胚胎着床率及临床妊娠率均无显著性差异（P〉0．05）。结论BMI过高会导致IVF／ICSI治疗过程中Gn用量增加和hCG日血清E2水平降低，早期流产率增加，对IVF的结局有一定的负面影响。

Effects of body mass index on the outcome of in vitro fertilization and embryo transfer treatment

Objective： To investigate the effect of body mass index （BMI） on the procedure and outcome of in vitro fertilization and embryo transfer （IVF-ET） and intracytoplasmic sperm injection （ICSI）. Methods： A retrospective study was carried out on 449 patients （age under 35 years old） who received IVF-ET and ICSI treatment in our hospital between Jun. 2006 and Jun. 2010. According to body mass index （BMI）, all patients were divided into three groups： low weight （group A, BMI〈18.5 kg/m^2 , 45 cycles）, normal weight （group B, 18.5 kg/m^2≤BMI〈25 kg/m^2, 356 cycles） and overweight （group C, BMI≥25 kg/m^2, 48 cycles）. The total dose and duration of gonadotropin（Gn）, the serum levels of estradiol （E2） and thickness of endometrium on the day of human chorionic gonadotropin （hCG） administration, number of retrieved oocytes, and the rates of fertilization, cleavage, high-quality embryo, implantation, clinical pregnancy and early miscarriage were compared among three groups. Results： There was no significant difference in number of retrieved oocytes, the rates of fertilization, cleavage, high-quality embryo, implantation and clinical pregnancy among three groups, but the dose of Gn increased significantly and the serum levels of E2 on the day of hCG administration decreased significantly in group C compared with those in groups A and B （P〈0. 05）, meanwhile, the early miscarriage rate in group C was significantly higher than that in group B （P〈0.05）.Conclusions： The excessive BMI would increase the total dose of Gn used and decrease the serum levels of E2 on the day of hCG administration, resulting in an increased early miscarriage rate.