体外受精/卵胞浆内单精子注射中鲜胚移植妊娠结局的影响因素分析

doi:10.13481/j.1671-587X.20220223

Abstract

Abstract: Objective

To investigate the related factors of pregnancy outcome after fresh embryo transfer in in-vitro fertilization/intra-cytoplasmic sperm injection（IVF/ICSI），and to provide a reference for making and optimizing the individualized transplantation strategy in chinic.

Methods

The clinical materials of 635 fresh embryo transfer in IVF/ICSI cycles were retrospsectively analyzed. According to the pregnancy outcome， they were divided into clinical pregnancy group （n=354） and non-pregnancy group （n=281）. The general data， clinical data and laboratory data of the patients in two groups were collected and univariate analysis was performed. The influencing factors with significant differences and clinical significance were included in multiple Logistic regression analysis.

Results

The univariate analysis results showed that there were 14 indicators with statistically significant differences between clinical pregnancy group and non-pregrancy group（P<0.25）. Combined with the clinical significance， 12 indicators were included in the multiple Logistic regression model. The results of multiple multiple Logistic regression analysis showed age of female （P=0.002）， number of antral follicle count（AFC）（P=0.031），serum progesterone （P） level on human chorionic gonadotropin（hCG） trigger day （P=0.007），number of useable embryo on Day 3 （P=0.002） and number of transferred embryos （P<0.001） were identified as the independent related factors of pregnancy outcome of fresh embryo transfer following assisted reproductive technology. Compared with the patients aged<35 years old， the patients aged ≥35 years old had a lower pregnancy rate by 45.4% （OR=0.546，OR95%CI：0.370－0.806）， the clinical pregnancy rate of the patients with serum P level on hCG trigger day≥1.0 μg·L^－1 was 38.1% lower than that of the patients with P level<1.0 μg·L^－1（OR=0.619，OR95%CI：0.437－0.877）and the clinical pregnancy rate of two embryos transfer was nearly doubled compared with single embryo transfer （OR=1.947，OR95%CI：1.375－2.757）. The clinical pregnancy rates of of the patients with AFC>15 and useable embryos>4 on Day 3 were increased to 48.5% （OR=1.485，OR95%CI：1.036－2.129） and 77.5% （OR=1.775，OR95%CI：1.240－2.541）， respectively.

Conclusion

Age of female， AFC， serum P level on hCG trigger day， number of useable embryo on Day 3 and number of transferred embryos are identified as the independent related factors of fresh embryo transfer outcome following assisted reproductive technology. Female aged<35 years old， AFC>15， serum P level on hCG trigger day <1.0 μg·L^－1，useable embryos on Day 3>4 and two embryos transfer contribute to improve the clinical pregnancy rate in fresh embryo transfer. It can be appropriately referred when making the transplantation strategy.

Key words: Fresh embryo transfer, In-vitro fertilization/intracytoplasmic sperm injection, Embryo transfer, Pregnancy rate, Assisted reproductive technology

CLC Number:

R715.9

Yuanyuan YE,Xiaohong YAN,Youzhu LI. Analysis on related factors of pregnancy outcome after fresh embryo transfer in in-vitro fertilization/ intra-cytoplasmic sperm injection[J].Journal of Jilin University(Medicine Edition), 2022, 48(2): 454-461.

Figures/Tables 5

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References 25

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Indicator	Clinical pregnancy group(n=354)	Non-pregnancy group(n=281)	t/χ²	P
Age	30.58±4.08	32.58±5.46	5.108	<0.001^*
Infertility duration (year)	3.21±2.31	3.41±2.63	0.973	0.331
AMH (μg·L^－1)	4.01±2.76	3.70±3.38	－1.143	0.253
Number of AFC	14.77±8.52	12.27±7.89	－3.825	<0.001^*
Infertility type			3.922	0.048^*
Primary	188（53.11）	127（45.20）
Secondary	166（46.89）	154（54.80）
BMI (kg·m^－2)			1.493	0.713^△
<18.5	37（10.54）	33（11.74）
18.5－24.9	243（68.64）	193（68.68）
25.0－29.9	64（18.08）	43（15.30）
≥30.0	9（2.54）	10（3.56）
Absence	1（0.28）	2（0.71）
Reasons for infertility
Pelivc and fallopian tube factors			0.682	0.409
Yes	218	182
No	136	99
Ovarian dysfunction			7.227	0.007^*
Yes	44	57
No	310	224
Polycystic ovarian syndrome			2.530	0.252
Yes	63	37
No	291	244
Endometriosis			0.848	0.357
Yes	49	32
No	305	249
Male factors			0.865	0.352
Yes	131	94
No	223	187

Indicator	Clinical pregnancy group (n=354)	Non-pregnancy group (n=281)	t/χ²	P
Number of Gn days	10.49±2.21	10.26±2.23	－1.252	0.251
Total amount of Gn (IU)	2 118.00±724.78	2 152.50±740.14	0.589	0.556
E2 on hCG trigger day [ρ_B/(ng·L^－1)]	2 984.80±1 342.33	2 911.30±1 400.23	－0.669	0.504
P on hCG trigger day [ρ_B/(μg·L^－1)]	0.83±0.32	0.92±0.41	2.933	0.004^*
P/E2×1 000 on hCG trigger day	0.28（0.19，0.43）	0.32（0.21，0.52）	－2.811	0.005^*
P/ MⅡ on hCG trigger day	0.09（0.06，0.15）	0.11（0.07，0.19）	－3.923	<0.001^*
Intimal thickness on hCG trigger day (l/cm)	11.87±2.26	11.89±2.42	0.125	0.900
Intimal type on hCG trigger day			0.685	0.710
A/A-B	44（12.43）	38（13.52）
B/B-C	253（71.47）	204（72.60）
C	57（16.10）	39（13.88）
Hyperovulation protocol			14.914	0.001^*?
Long protocol	245（69.21）	170（60.50）
Super-long protocol	40（11.30）	21（7.47）
Antagonist protocol	68（19.21）	86（30.60）
Others	1（0.28）	4（1.20）
Doctor			0.439	0.803
1	121（34.18）	98（34.87）
2	120（33.90）	100（35.59）
3	113（31.92）	83（29.54）

Indicator	Clinical pregnancy group（n=354）	Non-pregnancy group （n=281）	t/χ²	P
Number of oocytes retrieved	11.15±5.53	10.01±5.21	－2.664	0.008^*
Number of MⅡ oocytes	9.39±4.84	8.40±4.62	－2.620	0.009^*
Number of available embryos on Day 3	5.13±3.50	4.35±3.35	－2.849	0.005^*
Number of good embryos on Day 3	7.02±4.25	6.13±3.97	－2.665	0.008^*
Fertilization type			0.004	0.998
IVF	260(73.45)	206(73.31)
ICSI	78(22.03)	62(22.06)
Others	16(4.52)	13(4.63)
Number of transplanted embryos			9.379	0.002^*
1	147（41.53）	151（53.74）
2	207（58.47）	130（46.26）
Average score of transplanted embryos			8.377	0.015^*
1.0	39（11.08）	54（19.29）
1.5	48（13.64）	34（12.14）
2.0	265（75.28）	192（68.57）
Type of transplanted embryo			0.708	0.400
Blastomere on Day 3	254（71.75）	210（74.73）
Blastocyst on Day 5	100（28.25）	71（25.27）

Indicator	Assignment method
Age(year)	<35=0，≥35=1
Number of antral follicle count	≤15=0，>15=1
P on hCG trigger day	<1.0=0，≥1.0=1
Number of MⅡ oocytes	<10=0，≥10=1
Number of available embryos on Day 3	≤4=0，>4=1
Infertility type	Primary=0，Secondary=1
Ovarian dysfunction	No=0，Yes=1
Hyperovulation protocol	Long protocol=000，Antagonist protocol=100，Super-long protocol=010，others=001
Average score of transplanted embryos	Score1.0=00，Score1.5=10，Score2.0=01
Pregnancy outcome	Unpregnancy=0，pregnancy=1

Indicator	B	SE	Wald	P	OR	95%CI
Number of available embryos on Day 3	0.574	0.183	9.843	0.002	1.775	1.240－2.541
Progesterone on hCG trigger day	－0.479	0.177	7.307	0.007	0.619	0.437－0.877
Antral follicle count	0.395	0.184	4.626	0.031	1.485	1.036－2.129
Age(year)	－0.606	0.199	9.276	0.002	0.546	0.370－0.806
Number of transferred embryos	0.666	0.178	14.074	<0.001	1.947	1.375－2.757
Constant	－0.177	0.194	0.832	0.362	0.838	－
“－”：No data.

Analysis on related factors of pregnancy outcome after fresh embryo transfer in in-vitro fertilization/ intra-cytoplasmic sperm injection

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