| 孙晶雪,刘伟,郑娟,等.身体质量指数对卵巢储备下降病人行新鲜胚胎移植临床结局的影响分析[J].安徽医药,2023,27(7):1390-1396. |
| 身体质量指数对卵巢储备下降病人行新鲜胚胎移植临床结局的影响分析 |
| Effect of body mass index on clinical outcomes of patients with decreased ovarian reserve undergoing fresh embryo transfer |
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| DOI：10.3969/j.issn.1009-6469.2023.07.026 |
| 中文关键词: 卵巢储备功能 身体质量指数 年龄 改良长方案 体外受精 -胚胎移植 |
| 英文关键词: Ovarian reserve Body mass index Age Modified long down-regulation protocol In vitro fertilization -embryo transfer (IVF-ET) |
| 基金项目:厦门市医学优势亚专科建设项目(厦卫科教〔 2018〕296号) |
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| 中文摘要: |
| 目的了解不同年龄卵巢储备下降( diminished ovarian reserve，DOR)病人行改良长方案体外受精 -胚胎移植( in vitro fertilization -embryo transfer，IVF-ET)/单精子卵胞浆内显微注射( intracytoplasmic sperm injection，ICSI)的临床结局与身体质量指数( body mass index，BMI)的关系。方法回顾性分析 2013年 1月至 2021年 12月于陆军第七十三集团军医院行 IVF/ICSI新鲜胚胎移植的 DOR病人 1 752例，根据年龄不同分为 A组( <35岁)和 B组( ≥35岁)，根据 BMI进一步分为 3个亚组，即 A1(BMI<18.5)、 A2(18.5≤BMI<24)、 A3(24≤BMI<28)及 B1(BMI<18.5)、B2(18.5≤BMI<24)、 B3(24≤BMI<28)。分别比较 A及 B组 3个亚组间的一般情况、超促排卵情况、实验室及临床妊娠结局。通过 logistic回归分析不同 BMI对临床妊娠率的影响。结果超促排卵情况: A1组促性腺激素( gonadotropins，Gn)启动量［ 225.00(187.50，225.00)IU］及 Gn总量［ 2 512.50(2 250.00，2 775.00)IU］显著低于 A2［225.00(225.00，225.00)IU，2 700.00(2 325.00，2 925.00)IU］及 A3组［ 225.00(225.00，225.00)IU，2 925.00(2475.00，2 925，00)IU］； A1组 Gn启动时间［ 30.00(29.00，34.00)d］显著多于 A2组［ 30.00(29.00，33.00)d］，A3组人绒毛膜促性腺激素( human chorionic gonadotropin，HCG)日雌二醇水平［ 1 886.00(1 067.25，3 506.25)μg/L］显著低于 A1［2 634.00(1 698.00， 4 087.00)μg/L］及 A2组［ 2 470.50(1 461.00，3 746.25)μg/L］； B3组 Gn总量［ 2 925.00(2 662.50，3 150.00)IU］显著高于 B2组［ 2 700.00(2 475.00，3 150.00)IU］；实验室情况: A2组成熟卵数［ 7.00(4.00，9.00)个］、可利用胚胎数［ 4.00(3.00，6.00)个］及优质胚胎数［ 3.00(1.00，5.00)个］显著高于 A1组［ 6.00(4.00，8.00)个， 4.00(2.00，6.00)个， 3.00(1.00，4.00)个］，B1组可利用胚胎数［ 3.00(2.00，3.00)个］显著少于 B2组［ 3.00(2.00，5.00)个］及 B3组［ 3.00(2.00，5.50)个］； B1组临床妊娠率［ 33.33%(11/33)］显著低于 B3组［56.14%(32/57)］。 logistic多因素回归分析显示，校正混杂因素后， BMI对<35岁 DOR病人临床妊娠率的影响差异无统计学意义( P>0.05)，对≥35岁 DOR病人临床妊娠率的影响差异有统计学意义( P<0.05)。 ≥35岁 DOR病人单纯超重组的临床妊娠率显著高于低 BMI组， OR 95%CI:1.13(1.04，1.23)。结论单纯性超重 DOR病人可获得与正常 BMI病人相似的临床结局，但对 Gn反应性差，年轻病人可适当减重后行 IVF-ET，高龄病人可减重同时行 IVF-ET；低 BMI对 DOR病人的胚胎质量有负面影响，其中高龄低 BMI的 DOR病人的临床结局较差，可适当增重后行 IVF-ET。 |
| 英文摘要: |
| Objective To understand the relationship between clinical outcomes and body mass index (BMI) in decreased ovarianreserve (DOR) patients of different ages undergoing modified long protocol in vitro fertilization-embryo transfer (IVF-ET)/intracytoplasmic sperm injection (ICSI).Methods A retrospective analysis was performed on 1 752 DOR patients undergoing IVF / ICSI fresh embryo transfer at The 73rd Group Military Hospital of the Army from January 2013 to December 2021. Patiens were assigned into groupA (<35 years old) and group B (≥35 years old) according to age, group A and group B were further assigned into 3 subgroups accordingto body mass index, namely A1 (BMI<18.5), A2 (18.5≤BMI<24), A3 (24≤BMI<28) and B1 (BMI<18.5), B2 (18.5≤BMI<24), B3 (24≤BMI<28). The general conditions, superovulation conditions, laboratory and clinical pregnancy outcomes were compared between thethree subgroups of group A and group B, respectively. The effect of different BMI on clinical pregnancy rate was analyzed by Logisticregression.Results Situation of superovulation: the starting amount of Gonadotropins (Gn) [225.00(187.50,225.00) IU] and the totalamount of Gn [2 512.50(2 250.00,2 775.00) IU] in group A1 were significantly lower than those in group A2 [225.00(225.00,225.00)IU, 2 700.00(2 325.00,2 925.00) IU] and A3 [225.00(225.00,225.00) IU, 2 925.00(2 475.00,2 925.00)IU]; the starting time of Gn ingroup A1 [30.00(29.00,34.00) days] significantly more than that in group A2 [30.00(29.00,33.00)days]. The daily estradiol level of human chorionic gonadotropin (HCG) in group A3 [1 886.00(1 067.25,3 506.25) μg/L] was significantly lower than that of group A1 [2634.00(1 698.00, 4 087.00) μg/L] and group A2 [2 470.50(1 461.00, 3 746.25) μg/L]; the total Gn amount in group B3 [2 925.00(2662.50,3 150.00) IU] was significantly higher than that in group B2 [2 700.00(2 475.00,3 150.00) IU]. Laboratory conditions: the number of mature eggs [7.00 (4.00, 9.00)] and the number of available embryos [4.00 (3.00, 6.00)] and the number of high-quality embryos[3.00 (1.00, 5.00)] in group A2 were significantly higher than those in group A1 [6.00 (4.00, 8.00), 4.00 (2.00, 6.00), 3.00 (1.00, 4.00)],and the number of available embryos in group B1 [3.00 (2.00, 3.00)] was significantly less than that in group B2 [3.00 (2.00, 5.00)] andgroup B3 [3.00 (2.00, 5.50)]. The clinical pregnancy rate [33.33% (11/33)] in group B1 was statistically significant lower than that ingroup B3 [56.14% (32/57)]. Logistic multivariate regression analysis showed that after adjusting for confounding factors, BMI had nosignificant effect on the clinical pregnancy rate of DOR patients aged <35 years (P>0.05), but had a statistically significant effect on the clinical pregnancy rate of DOR patients aged ≥35 years (P>0.05). The clinical pregnancy rate of overweight group was significantlyhigher than that of underweight group in DOR patients ≥35 years old [OR 95%CI: 1.13 (1.04, 1.24)].Conclusions Simple overweight DOR patients can achieve similar clinical outcomes as normal-weight patients, but have poor response to Gn. Young patients can undergo IVF-ET after appropriate weight loss, and elderly patients can lose weight and undergo IVF-ET at the same time. Low body mass hasa negative effect on the embryo quality of patients with DOR, and the clinical outcome of DOR patients with advanced age and low bodyweight is poor, and IVF-ET can be performed after appropriate weight gain. |
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