目的 探讨卵巢功能减退(DOR)患者多周期累积与非累积胚胎移植体外受精-胚胎移植(IVF-ET)临床结局的差异。方法 回顾性分析2019-01至2022-12于首都医科大学附属北京妇产医院生殖医学科进行IVF-ET治疗的卵巢储备功能减退的不孕患者174例的临床资料,纳入患者均已完成所有胚胎移植及最终随访。收集患者的基础内分泌、抗苗勒管激素水平及窦卵泡计数,记录促排卵治疗后的卵巢反应参数及妊娠结局等相关临床资料,比较多周期累积胚胎移植(累积组)与非累积胚胎移植(非累积组)两种IVF-ET治疗的临床结局。结果 DOR患者多周期累积胚胎移植与非累积胚胎移植两组间的累积妊娠率(35.24% vs. 27.54% )、早期流产率(32.43% vs. 26.32%)及累积活产率(21.90% vs. 18.84%)差异无统计学意义(P>0.05);纳入移植策略、BMI、首次取卵年龄、AMH、胚胎移植数、优质胚胎移植数、累积获卵数等多个因素后进行logistic回归分析,两种不同的胚胎移植策略(OR=1.522,95%CI 0.608～3.814)对活产无明显影响(P>0.05)。结论 对于DOR患者,进行多周期重复取卵后的累积胚胎移植并不能提高患者的累积妊娠率及活产率。
Abstract
Objective To investigate the clinical outcomes in vitro fertilization-embryo transfer (IVF-ET) in patients with diminished ovarian reserve (DOR) after multi-cycle cumulative and non-cumulative embryo transfer strategies. Methods Clinical data of 174 patients with DOR who underwent IVF-ET treatment in the Department of Human Reproductive Medicine, Beijing Obstetrics and Gynecology Hospital Affiliated to Capital Medical University from January 2019 to December 2022 were retrospectively analyzed. All the included patients had completed all embryo transfer and final follow-up. Basic endocrine, anti-mullerian hormone levels and sinus follicle counts of the patients were collected, and relevant clinical data such as ovarian response parameters and pregnancy outcomes after ovulation induction therapy were recorded.The clinical outcomes of multi-cycle cumulative embryo transfer (cumulative group) and non-cumulative embryo transfer (non-cumulative group) were compared. Results No statistically significant differences were found in terms of cumulative pregnancy rate (35.24% vs. 27.54%), early abortion rate (32.43% vs. 26.32%), and cumulative live birth rate (21.90% vs. 18.84%) between the two groups of DOR patients with multiple-cycle cumulative embryo transfer and non-cumulative embryo transfer (P>0.05). logistic regression analysis was performed after taking into account multiple factors such as transplantation strategy, BMI, age of first egg retrieval, AMH, number of embryo transfer, number of high-quality embryo transfer, and cumulative number of eggs obtained, and two different embryo transfer strategies (OR=1.522, 95% CI 0.608-3.814) had no significant impact on live birth (P>0.05). Conclusions For patients with DOR, cumulative embryo transfer after multiple cycles of repeated egg retrieval can not improve the cumulative pregnancy rate and live birth rate.
关键词
卵巢功能减退 /
累积胚胎移植 /
多周期累积活产率
Key words
diminished ovarian reserve /
cumulative embryo transfer /
cumulative live birth rate in multiple cycles
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Pastore L M, Christianson M S, Stelling J, et al. Reproductive ovarian testing and the alphabet soup of diagnoses: DOR, POI, POF, POR, and FOR[J]. J Assist Reprod Genet, 2018,35(1):17-23.
[2] Zhang Y, Zhang C, Shu J, et al. Adjuvant treatment strategies in ovarian stimulation for poor responders undergoing IVF: a systematic review and network meta-analysis[J]. Hum Reprod Update, 2020,26(2):247-263.
[3] Yu R, Jin H, Huang X, et al. Comparison of modified agonist, mild-stimulation and antagonist protocols for in vitro fertilization in patients with diminished ovarian reserve[J]. J Int Med Res, 2018,46(6):2327-2337.
[4] Hu S, Xu B, Jin L. Perinatal outcome in young patients with diminished ovarian reserve undergoing assisted reproductive technology[J]. Fertil Steril, 2020,114(1):118-124.
[5] Ata B, Seyhan A, Seli E. Diminished ovarian reserve versus ovarian aging: overlaps and differences[J]. Curr Opin Obstet Gynecol, 2019, 31(3): 139-147.
[6] 中国医师协会生殖医学专业委员会.基于单次促排卵周期的累积分娩/活产率专家共识[J]. 中华生殖与避孕杂志, 2018, 38(12): 963-968.
[7] Takahashi T, Igarashi H, Amita M, et al. Molecular mechanism of poor embryo development in postovulatory aged oocytes: mini review[J]. J Obstet Gynaecol Res, 2013, 39(10): 1431-1439.
[8] Han L, Wang H, Li L, et al. Melatonin protects against maternal obesity-associated oxidative stress and meiotic defects in oocytes via the SIRT3-SOD2-dependent pathway[J]. J Pineal Res, 2017, 63(3):1-29.
[9] Chen Y H, Xu X H, Wang Q, et al. Optimum oocyte retrieved and transfer strategy in young women with normal ovarian reserve undergoing a long treatment protocol:a retrospective cohort study[J]. J Assist Reprod Genet, 2015, 32(10):1459-1467.
[10] 刘 景, 周梦鸽, 李 真, 等. 女性年龄与获卵数对体外受精-胚胎移植累积活产率的影响[J]. 郑州大学学报(医学版), 2022, 57(4): 547-551.
[11] Vaiarelli A, Cimadomo D, Ubaldi N, et al. What is new in the management of poor ovarian response in IVF?[J]. Curr Opin Obstet Gynecol, 2018, 30(3): 155-162.
[12] Law Y J, Zhang N, Venetis C A, et al. The number of oocytes associated with maximum cumulative live birth rates per aspiration depends on female age: a population study of 221 221 treatment cycles[J]. Hum Reprod, 2019, 34(9): 1778-1787.
[13] Goldman R H, Racowsky C, Farland L V, et al. Predicting the likelihood of live birth for elective oocyte cryopreservation: a counseling tool for physicians and patients[J]. Hum Reprod, 2017, 32(4): 853-859.
[14] Gu F, Ruan S, Luo C, et al. Can repeat IVF/ICSI cycles compensate for the natural decline in fertility with age? an estimate of cumulative live birth rates over multiple IVF/ICSI cycles in Chinese advanced-aged population[J]. Aging (Albany NY), 2021,13(10):14385-14398.
[15] 李 欣, 周星宇, 张 俊, 等. 高龄女性累积胚胎后移植与非累积胚胎移植的妊娠结局分析[J]. 广东医学, 2021, 42(8): 877-882.
[16] Yang J H, Chen C D, Chen S U, et al. Factors influencing the recurrence potential of benign endometrial polyps after hysteroscopic polypectomy[J]. PLoS One, 2015, 10(12): e144857.
[17] Mossa B, Patella A, Ebano V, et al. Microsurgery versus laparoscopy in distal tubal obstruction hysterosalpingographically or laparoscopically investigated[J]. Clin Exp Obstet Gynecol, 2005, 32(3): 169-171.
基金
国家自然科学基金面上项目(81871133);北京市医院管理中心“登峰”计划专项经费(DFL20191401)
PDF(973 KB)
