体外受精-胚胎移植技术妊娠后流产的危险因素分析

目的:探讨体外受精-胚胎移植技术妊娠后流产的危险因素。方法:采用t检验、受试者工作特征曲线(Receiver operating characteristic curve,ROC曲线)以及二元Logistic回归分析分别对2015年1月至2017年12月我中心行体外受精-胚胎移植技术(In vitro fertilization and embryo transfer,IVF-ET)及卵胞浆内单精子注射技术(Intracytoplasmic sperm injection,ICSI)后妊娠的242例临床妊娠患者临床参数包括年龄、身体质量指数(Body mass index,BMI)、基础卵泡生成素(Follicle stimulating hormone,FSH)、黄体生成素(Luteinizing hormone,LH)、雌二醇(Estradiol,E2)水平、促性腺激素(Gonadotropins,Gn)总用量、Gn天数、人绒毛膜促性腺激素(Human choionic gonadotophin,HCG)日LH、E2、黄体酮(progesterone,P)水平、移植日子宫内膜厚度以及移植后14-16天血HCG浓度进行回顾性分析。结果:流产组与继续妊娠组年龄、移植后14-16天血HCG浓度分别31.44±4.40岁和29.59±3.94岁、396.96±377.66 IU/L和702.85±496.91 IU/L,差异具有统计学意义(P<0.05)。通过ROC曲线对各临床参数分析后求得各参数的cut-off值并以此为标准分组,结果显示不同年龄(29.41%和9.42%)以及移植后14-16天血HCG浓度(4.20%和22.76%)分组流产率比较差异具有显著的统计学意义(P<0.01)。二元Logistic回归分析上述参数与流产率的相关性,结果提示仅年龄、移植后14-16天血HCG水平与妊娠后流产率有显著相关性(P=0.01,P=0.001)。结论:年龄>33岁、移植后14-16天血HCG浓度≤582.6IU/L是IVF/ICSI妊娠后流产的独立危险因素,对此类患者进行治疗时应考虑到其流产的风险并提前采取预防措施避免不良妊娠结局。

Analysis of Risk Factors of Abortion after Encyesis in Vitro Fertilization and Embryo Transfer

Objective: To explore the relative factors for miscarriage among pregnancies produced by assisted reproductive technology. Methods: A total of 242 cycles of in vitro fertilization and intra-cytoplasmic sperm injection that resulted in a clinical pregnancy from January 2015 to December 2017 were included. Female age, BMI, basal FSH, basal LH, basal E2, total gonadotrophin dose, the days of gonadotropin use, LH on day of hCG, E2 on day of hCG, P on day of hCG, endometrial thickness on day of embryo transfer andβ-HCG level at 14 to 16 days post-ET and embryo quality were analyzed by Independent samples t-test, receiver operating characteristic curve and binary logistic regression analysis. Results: Female age and β-HCG level in the miscarriage group and Ongoing pregnancy group at 14 to 16 days post-ET was 31.44±4.40 vs. 29.59±3.94 and 396.96±377.66 IU/L vs. 702.85±496.91 IU/L(P<0.05). The ROC curve is obtained for analysis of various clinical parameters, and miscarriage rate were significant difference in cut-off group based on female age(29.41% vs 9.42%) and β-HCG level at 14 to16 days post-ET(4.20% vs 22.76%). Binary logistic regression analysis showed that, from all of the parameters, only female age and β-HCG level at 14 to 16 days post-ET has an independent significant correlation between miscarriage rate(P=0.001). Conclusion: Female age>33 or β-HCG level at 14 to16 days post-ET≤ 582.6 IU/L was the risk factors of miscarriage in the IVF/ICSI. The risk factors should be taken into account in the treatment of such patients and preventive measures should be taken in advance to avoid adverse pregnancy outcomes.