IVF-ET临床妊娠率和活产率及其影响因素研究

发布时间：2019-06-12 04:49

【摘要】：[背景]不孕不育相关疾病的发生率呈逐年上升趋势,体外受精-胚胎移植(invitro fertilization-embryo transfer,IVF-ET)技术是治疗不孕不育疾病有效、有时候也是唯的手段。提高IVF-ET临床妊娠率和活产率是辅助生殖技术重要研究课题。[目标]了解2005-2010年某不孕不育诊疗中心IVF-ET临床妊娠率、活产率(抱婴率)及其变化趋势,分析并探讨影响IVF-ET成功率的个体和临床因素,以找出改进方法,提高IVF-ET成功率。[资料及方法]本文资料来源于上海集爱遗传与不育诊疗中心2005-2010年收治实施IVF-ET技术的全部病例,患者一般状况及相关临床数据来自电子病历,成功妊娠分娩后,新生儿信息通过随访获取。采用单因素卡方、分层分析等统计方法,分析不同年份IVF-ET新鲜周期／冷冻周期临床妊娠率及活产率以及单周期累积成功率,并通过二分类多元logistic回归模型分析新鲜周期和冷冻周期单次移植临床妊娠率和活产率的影响因素。分析软件为SPSS 16.0。[结果]2005至2010年本中心实施IVF-ET病例数分别为1004、1328、1359、1853、2220、2029例,共9793例。新鲜周期单次移植成功率方面,该中心2005-2010年整体临床妊娠率为35.5%,2005-2010年历年临床妊娠率分别为40.7%、39.9%、36.7%、38.3%、34.3%、31.6%,呈逐年下降趋势。多因素分析结果表明,妇女年龄越大、子宫内膜厚度越薄会显著降低IVF-ET临床妊娠率,并且其于长短方案选择和Gn用量有关。2005-2009年5年合计的平均活产率为27.9%,历年活产率分别为32.8%、30.3%、28.2%、27.2%、25.1%,比对应年份的临床妊娠率低约7%-9%,多因素分析表明妇女年龄越大、子宫内膜厚度越薄显著降低IVF-ET的活产率,并目其与受精数、原发/继发、及实验员有关。冷冻周期2005-2010年_单次移植临床妊娠成功率分别为35.6%、37.8%、36.7%、33.1%、28.5%、31.0%。多因素分析结果显示,妇女年龄越大、子宫内膜厚度越薄、冷冻数量越低、秋季移植者的临床妊娠率显著下降。2005-2009年冷冻周期移植活产率依次为35.1%、35.9%、34.9%、31.5%、27.1%,下降趋势明显。冷冻周期活产率的影响因素主要有妇女的年龄、子宫内膜厚度和移植季节。年龄越大、子宫内膜越薄以及秋季移植的活产率较低。2005-2010年期间同一周期最多者曾做7次移植,1至7次单次的临床妊娠率分别为28.3%、39.4%、41.5%、37.2%、34.2%、40.0%和100%,三次以上患者对象数急剧下降。2005-2010单周期累积临床妊娠率分别为65.2%、64.6%、57.8%、50.4%、54.1%、45.0%。2005-2009年单周期累积活产率分别为50.0%、47.1%、42.5%、38.3%、39.4%。单次及累积临床妊娠率和活产率主要与该中心在资料收集期间促排卵方案以及政府对IVF-ET移植数量限制有关。[结论]妇女年龄是影响IVF-ET临床妊娠率和活产率的重要因素,年龄越大成功率越低。在确诊不孕不育后,应鼓励妇女趁早实施辅助生殖技术,提供IVF-ET服务时,宜慎重增加Gn使用剂量,合理控制取卵数量,采取措施增加妇女子宫内膜厚度,对部分医技人员应增加技能培训,以提高IVF-ET成功率。
[Abstract]:[Background] The incidence of infertility associated with infertility is increasing year by year, and in vitro fertilization-embryo transfer (IVF-ET) is an effective and sometimes only means to treat infertility. The improvement of the clinical pregnancy rate and the live birth rate of the IVF-ET is an important subject of secondary reproductive technology. [Objective] To study the clinical pregnancy rate, live birth rate and its trend of IVF-ET in an infertility treatment center from 2005 to 2010, and to analyze and discuss the individual and clinical factors that influence the success rate of IVF-ET in order to find an improved method and improve the success rate of IVF-ET. [Materials and Methods] This paper is derived from all cases of the implementation of IVF-ET in the 2005-2010 center of Shanghai Jiayai Genetics and Infertility Treatment Center. The general condition of the patient and the relevant clinical data are from the electronic medical record. After successful pregnancy, the information of the newborn is obtained by follow-up. The clinical pregnancy rate and the live birth rate and the single cycle cumulative success rate of the IVF-ET fresh cycle/ freezing cycle in different years are analyzed by a statistical method such as a single factor square, a hierarchical analysis, and the like. The clinical pregnancy rate and the rate of live birth were analyzed by a two-class multi-logistic regression model. The software was SPSS 10.0. [Results] The number of cases of IVF-ET in this center from 2005 to 2010 were 1004,1328,1359,1853,2220 and 2029, with a total of 9793 cases. The overall clinical pregnancy rate was 35.5% in 2005-2010, 40.7%, 39.9%, 36.7%, 38.3%, 34.3%, 31.6%, respectively. The results of multi-factor analysis show that the greater the age of women, the thinner the thickness of the endometrium, the clinical pregnancy rate of the IVF-ET can be significantly reduced, and it is related to the selection of the long and short protocols and the amount of Gn. The average live birth rate for 2005-2009 is 27.9%, and the live birth rate in the years is 32.8%, 30.3%, 28.2%, 27.2%, respectively. 25.1%, which is about 7% to 9% lower than the clinical pregnancy rate in the corresponding year, and the multi-factor analysis indicates that the greater the age of women, the thinner the thickness of the endometrium, and the lower the live birth rate of the IVF-ET, and it is related to the number of fertilization, the primary/ secondary, and the experimenter. The success rate of single-dose clinical pregnancy was 35.6%, 37.8%, 36.7%, 33.1%, 28.5%, 31.0%, respectively. The results of multi-factor analysis showed that the higher the age of women, the thinner the thickness of the endometrium, the lower the number of frozen, the lower the clinical pregnancy rate of the transplant in the fall. The rate of live birth in the frozen-cycle in 2005-2009 was 35.1%, 35.9%, 34.9%, 31.5%, 27.1%, and the decline trend was obvious. The influencing factors of the live birth rate of the frozen cycle are mainly the age of women, the thickness of the endometrium and the time of the transplantation. The greater the age, the thinner the endometrium and the lower rate of live birth in the fall. The same cycle of the same cycle had been 7 transplantations during the period 2005-2010, with a single clinical pregnancy rate of 28.3%, 39.4%, 41.5%, 37.2%, 34.2%, 40.0%, and 100%, respectively, during the period 2005-2010. The number of patients with three or more patients decreased sharply. The cumulative clinical pregnancy rate in the period 2005-2010 was 65.2%, 64.6%, 57.8%, 50.4%, 54.1%, 45.0%, respectively. The cumulative live birth rate in the single-cycle period 2005-2009 was 50.0%, 47.1%, 42.5%, 38.3%, 39.4%, respectively. The single and cumulative clinical pregnancy rate and the live birth rate were mainly related to the induction of ovulation by the center during data collection and the Government's limitations on the number of IVF-ET transplantation. [Conclusion] The age of women is an important factor that affects the clinical pregnancy rate and the live birth rate of the IVF-ET. The higher the age, the lower the success rate. In order to improve the success rate of IVF-ET, women should be encouraged to increase the dosage of Gn, to control the number of eggs, to take measures to increase the thickness of women's endometrium, and to increase the success rate of IVF-ET.
【学位授予单位】：复旦大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R714.8

【参考文献】