Krog Maria, Prior Maria, Carlsen Elisabeth, Loft Anne, Forman Julie, Pinborg Anja, Andersen Anders Nyboe
Fertility Clinic, section 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Fertility Clinic, section 4071, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, 2100 Copenhagen, Denmark.
Eur J Obstet Gynecol Reprod Biol. 2015 Jan;184:32-7. doi: 10.1016/j.ejogrb.2014.10.037. Epub 2014 Oct 30.
To identify predictors of total fertilization failure (TFF) and thereby optimize the primary allocation of patients with no well-defined male factor to either IVF or intracytoplasmatic sperm injection (ICSI). Further, to evaluate the long-term fertility prognosis of couples experiencing TFF.
A retrospective case-control study including 304 couples with TFF and 304 controls with fertilization after IVF during a 10-year period from year 2000-2010. The controls were the patients with minimum one fertilized oocyte just prior to the cases. Multiple logistic regression analysis was used to evaluate the predictors of TFF.
The multiple regression analysis identified the following independent predictors of TFF: female smoking, adjusted odds ratio (AOR) 1.7 (95% CI 1.1-2.3), non-tubal factor AOR 2.2 (95% CI 1.5-3.4), progressive motile spermatozoa after preparation × 10(6)/ml (Log2 scale) AOR 1.4 (95% CI 1.2-1.6). For every oocyte, decreasing from four to one oocytes, the risk of TFF increased with AOR 2.0 (95% CI: 1.5-2.9) and from seven to four oocytes with AOR 1.2 (95%CI: 1.0-1.3), respectively. In case of more than seven oocytes the risk of TFF did not vary significantly by the number of oocytes. Female age, BMI, duration of infertility, earlier natural or IUI conceptions were not predictors of TFF. After a minimum of 30 months of follow-up from the index cycle, 50% of the TFF patients succeeded in a live childbirth compared with 70% of the controls. Only thirty five percent of the total number of births in the TFF patients was after ICSI.
The risk of TFF is associated with the number of available oocytes for fertilization, female smoking, non-tubal factor infertility and an apparently minor sperm factor. However, anticipated predictors like advanced female age, duration of infertility and earlier conceptions proved not to have any predictive value. Couples experiencing TFF have a significantly reduced overall long-term chance of live birth compared with controls.
确定全受精失败（TFF）的预测因素，从而优化对无明确男性因素的患者进行体外受精（IVF）或卵胞浆内单精子注射（ICSI）的初次分配。此外，评估经历TFF的夫妇的长期生育预后。
一项回顾性病例对照研究，纳入了2000年至2010年期间的304对TFF夫妇和304例IVF后受精的对照夫妇。对照是在病例之前至少有一个受精卵母细胞的患者。采用多因素logistic回归分析评估TFF的预测因素。
多因素回归分析确定了以下TFF的独立预测因素：女性吸烟，调整优势比（AOR）为1.7（95%可信区间1.1 - 2.3）；非输卵管因素AOR为2.2（95%可信区间1.5 - 3.4）；处理后进行性活动精子×10(6)/ml（对数2尺度）AOR为1.4（95%可信区间1.2 - 1.6）。对于每个卵母细胞，从四个减少到一个卵母细胞，TFF风险以AOR 2.0（95%可信区间：1.5 - 2.9）增加，从七个减少到四个卵母细胞，AOR分别为1.2（95%可信区间：1.0 - 1.3）。在有超过七个卵母细胞的情况下，TFF风险随卵母细胞数量变化不显著。女性年龄、体重指数、不孕持续时间、既往自然受孕或宫腔内人工授精受孕情况均不是TFF的预测因素。从索引周期开始至少随访30个月后，50%的TFF患者成功分娩活婴，而对照组为70%。TFF患者分娩总数中只有35%是在ICSI后。
TFF风险与可用于受精的卵母细胞数量、女性吸烟、非输卵管因素不孕和明显轻微的精子因素有关。然而，预期的预测因素如女性高龄、不孕持续时间和既往受孕情况被证明没有任何预测价值。与对照组相比，经历TFF的夫妇总体长期活产机会显著降低。
