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身体质量指数对卵巢储备下降...胚胎移植临床结局的影响分析_孙晶雪.pdf
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身体 质量 指数 卵巢 储备 下降 胚胎 移植 临床 结局 影响 分析 孙晶雪
安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Jul,27(7)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孙晶雪,刘伟,郑娟,郭岩文,任建枝作者单位:陆军第七十三集团军医院生殖中心,福建 厦门361000通信作者:郑娟,女,副主任医师,研究方向为生殖内分泌,Email: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)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(BMI18.5)、A2(18.5BMI24)、A3(24BMI28)及B1(BMI18.5)、B2(18.5BMI24)、B3(24BMI28)。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(2 475.00,2 925,00)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)g/L 显著低于A1 2 634.00(1 698.00,4 087.00)g/L 及A2组 2 470.50(1 461.00,3 746.25)g/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0.05),对35岁DOR病人临床妊娠率的影响差异有统计学意义(P0.05)。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。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Effect of body mass index on clinical outcomes of patients with decreased ovarian reserve undergoing fresh embryo transferSUN Jingxue,LIU Wei,ZHENG Juan,GUO Yanwen,REN JianzhiAuthor Affiliation:Center of Reproductive Medicine,The 73rd Group Military Hospital of the Army,Xiamen,Fujian 361000,ChinaAbstract:Objective To understand the relationship between clinical outcomes and body mass index(BMI)in decreased ovarian reserve(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 group A(35 years old)and group B(35 years old)according to age,group A and group B were further assigned into 3 subgroups according to body mass index,namely A1(BMI18.5),A2(18.5BMI24),A3(24BMI28)and B1(BMI18.5),B2(18.5BMI24),B3(24BMI28).The general conditions,superovulation conditions,laboratory and clinical pregnancy outcomes were compared between the three subgroups of group A and group B,respectively.The effect of different BMI on clinical pregnancy rate was analyzed by Logistic regression.Results Situation of superovulation:the starting amount of Gonadotropins(Gn)225.00(187.50,225.00)IU and the total amount 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)临床医学引用本文: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.DOI:10.3969/j.issn.1009-6469.2023.07.026.1390安 徽 医 药 Anhui Medical and Pharmaceutical Journal 2023 Jul,27(7)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 in group 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)g/L was significantly lower than that of group A1 2 634.00(1 698.00,4 087.00)g/L and group A2 2 470.50(1 461.00,3 746.25)g/L;the total Gn amount in group B3 2 925.00(2 662.50,3 150.00)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)and group B3 3.00(2.00,5.50).The clinical pregnancy rate 33.33%(11/33)in group B1 was statistically significant lower than that in group B3 56.14%(32/57).Logistic multivariate regression analysis showed that after adjusting for confounding factors,BMI had no significant effect on the clinical pregnancy rate of DOR patients aged 0.05),but had a statistically significant effect on the clinical pregnancy rate of DOR patients aged 35 years(P0.05).The clinical pregnancy rate of overweight group was significantly higher than that of underweight group in DOR patients 35 year

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