• 文献检索
  • 文档翻译
  • 深度研究
  • 学术资讯
  • Suppr Zotero 插件Zotero 插件
  • 邀请有礼
  • 套餐&价格
  • 历史记录
应用&插件
Suppr Zotero 插件Zotero 插件浏览器插件Mac 客户端Windows 客户端微信小程序
定价
高级版会员购买积分包购买API积分包
服务
文献检索文档翻译深度研究API 文档MCP 服务
关于我们
关于 Suppr公司介绍联系我们用户协议隐私条款
关注我们

Suppr 超能文献

核心技术专利:CN118964589B侵权必究
粤ICP备2023148730 号-1Suppr @ 2026

文献检索

告别复杂PubMed语法,用中文像聊天一样搜索,搜遍4000万医学文献。AI智能推荐,让科研检索更轻松。

立即免费搜索

文件翻译

保留排版,准确专业,支持PDF/Word/PPT等文件格式,支持 12+语言互译。

免费翻译文档

深度研究

AI帮你快速写综述,25分钟生成高质量综述,智能提取关键信息,辅助科研写作。

立即免费体验

单侧卵巢切除术后行 IVF/ICSI 妇女活产率降低:一项多中心队列研究结果。

Reduced live-birth rates after IVF/ICSI in women with previous unilateral oophorectomy: results of a multicentre cohort study.

机构信息

Department of Obstetrics and Gynecology, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden.

Department of Clinical Science and Education, Södersjukhuset, Sjukhusbacken 10, 118 83 Stockholm, Sweden.

出版信息

Hum Reprod. 2018 Feb 1;33(2):238-247. doi: 10.1093/humrep/dex358.

DOI:10.1093/humrep/dex358
PMID:29211889
Abstract

STUDY QUESTION

Is there a reduced live-birth rate (LBR) after IVF/ICSI treatment in women with a previous unilateral oophorectomy (UO)?

SUMMARY ANSWER

A significantly reduced LBR after IVF/ICSI was found in women with previous UO when compared with women with intact ovaries in this large multicentre cohort, both crudely and after adjustment for age, BMI, fertility centre and calendar period and regardless of whether the analysis was based on transfer of embryos in the fresh cycle only or on cumulative results including transfers using frozen-thawed embryos.

WHAT IS KNOWN ALREADY

Similar pregnancy rates after IVF/ICSI have been previously reported in case-control studies and small cohort studies of women with previous UO versus women without ovarian surgery. In all previous studies multiple embryos were transferred. No study has previously evaluated LBR in a large cohort of women with a history of UO.

STUDY DESIGN, SIZE, DURATION: This research was a multicentre cohort study, including five reproductive medicine centres in Sweden: Carl von Linné Clinic (A), Karolinska University Hospital (B), Uppsala University Hospital (C), Linköping University Hospital (D) and Örebro University Hospital (E). The women underwent IVF/ICSI between January 1999 and November 2015. Single embryo transfer (SET) was performed in approximately 70% of all treatments, without any significant difference between UO exposed women versus controls (68% versus 71%), respectively (P = 0.32), and a maximum of two embryos were transferred in the remaining cases. The dataset included all consecutive treatments and fresh and frozen-thawed cycles.

PARTICIPANTS/MATERIALS, SETTING, METHODS: The exposed cohort included 154 women with UO who underwent 301 IVF/ICSI cycles and the unexposed control cohort consisted of 22 693 women who underwent 41 545 IVF/ICSI cycles. Overall, at the five centres (A-E), the exposed cohort underwent 151, 34, 35, 41 and 40 treatments, respectively, and they were compared with controls of the same centre (18 484, 8371, 5575, 4670 and 4445, respectively). The primary outcome was LBR, which was analysed per started cycle, per ovum pick-up (OPU) and per embryo transfer (ET). Secondary outcomes included the numbers of oocytes retrieved and supernumerary embryos obtained, the Ovarian Sensitivity Index (OSI), embryo quality scores and cumulative pregnancy rates. We used a Generalized Estimating Equation (GEE) model for statistical analysis in order to account for repeated treatments.

MAIN RESULTS AND THE ROLE OF CHANCE

The exposed (UO) and control women's groups were comparable with regard to age and performance of IVF or ICSI. Significant differences in LBR, both crude and age-adjusted, were observed between the UO and control groups: LBR per started cycle (18.6% versus 25.4%, P = 0.007 and P = 0.014, respectively), LBR/OPU (20.3% versus 27.1%, P = 0.012 and P = 0.015, respectively) and LBR/ET (23.0% versus 29.7%, P = 0.022 and P = 0.025, respectively). The differences in LBR remained significant after inclusion of both fresh and frozen-thawed transfers (both crude and age-adjusted data): LBR/OPU (26.1% versus 34.4%, P = 0.005 and P = 0.006, respectively) and LBR/ET (28.3% versus 37.1%, P = 0.006 and P = 0.006, respectively). The crude cancellation rate was significantly higher among women with a history of UO than in controls (18.9% versus 14.5%, P = 0.034 and age-adjusted, P = 0.178). In a multivariate GEE model, the cumulative odds ratios for LBR (fresh and frozen-thawed)/OPU (OR 0.70, 95% CI 0.52-0.94, P = 0.016) and LBR (fresh and frozen-thawed)/ET (OR 0.68, 95% CI 0.51-0.92, P = 0.012) were approximately 30% lower in the group of women with UO when adjusted for age, BMI, reproductive centre, calendar period and number of embryos transferred when appropriate. The OSI was significantly lower in women with a history of UO than in controls (3.6 versus 6.0) and the difference was significant for both crude and age-adjusted data (P = <0.001 for both). Significantly fewer oocytes were retrieved in treatments of women with UO than in controls (7.2 versus 9.9, P = <0.001, respectively).

LIMITATIONS, REASONS FOR CAUTION: Due to the nature of the topic, this is a retrospective analysis, with all its inherent limitations. Furthermore, the cause for UO was not possible to obtain in all cases. A diagnosis of endometriosis was also more common in the UO group, i.e. a selection bias in terms of poorer patient characteristics in the UO group cannot be completely ruled out. However, adjustment for all known confounders did not affect the general results.

WIDER IMPLICATIONS OF THE FINDINGS

To date, this is the largest cohort investigated and the first study indicating an association of achieving reduced live birth after IVF/ICSI in women with previous UO. These findings are novel and contradict the earlier notion that IVF/ICSI treatment is not affected, or is only marginally affected by previous UO.

STUDY FUNDING/COMPETING INTEREST(S): None.

TRIAL REGISTRATION NUMBER

Not applicable.

摘要

研究问题

在接受 IVF/ICSI 治疗的女性中,单侧卵巢切除(UO)是否会降低活产率(LBR)?

总结答案

在这项大型多中心队列研究中,与卵巢完整的女性相比,单侧卵巢切除的女性在接受 IVF/ICSI 治疗后,LBR 显著降低,这种差异无论是在粗观分析还是在调整年龄、BMI、生殖中心和周期后,以及是否基于新鲜周期的胚胎移植或包括冷冻-解冻胚胎移植的累积结果进行分析时,都仍然存在。

已知情况

先前的病例对照研究和单侧卵巢切除女性与无卵巢手术女性的小型队列研究报告了类似的 IVF/ICSI 后妊娠率。在所有先前的研究中,都移植了多个胚胎。之前没有研究评估单侧卵巢切除史的女性的 LBR 情况。

研究设计、规模、持续时间:这是一项多中心队列研究,包括瑞典的五家生殖医学中心:卡尔林奈诊所(A)、卡罗林斯卡大学医院(B)、乌普萨拉大学医院(C)、林雪平大学医院(D)和厄勒布鲁大学医院(E)。这些女性于 1999 年 1 月至 2015 年 11 月接受了 IVF/ICSI 治疗。大约 70%的治疗中进行了单胚胎移植(SET),UO 暴露的女性与对照组之间没有显著差异(分别为 68%和 71%)(P=0.32),其余病例中移植了最多两个胚胎。该数据集包括所有连续的治疗和新鲜与冷冻-解冻周期。

参与者/材料、设置、方法:暴露组包括 154 名单侧卵巢切除的女性,她们接受了 301 次 IVF/ICSI 周期,未暴露组的对照组包括 22693 名女性,她们接受了 41545 次 IVF/ICSI 周期。总的来说,在这五个中心(A-E),暴露组分别进行了 151、34、35、41 和 40 次治疗,并且与同一中心的对照组进行了比较(18484、8371、5575、4670 和 4445)。主要结局是 LBR,根据起始周期、取卵(OPU)和胚胎移植(ET)进行分析。次要结局包括获得的卵母细胞数量和多余胚胎数量、卵巢敏感性指数(OSI)、胚胎质量评分和累积妊娠率。我们使用广义估计方程(GEE)模型进行统计分析,以考虑重复治疗。

主要结果和机会作用

暴露组(UO)和对照组女性在年龄和接受 IVF 或 ICSI 方面具有可比性。在 LBR 方面,UO 和对照组之间存在显著差异,无论是在粗观分析还是在年龄调整后:起始周期的 LBR(18.6%对 25.4%,P=0.007 和 P=0.014)、OPU 的 LBR(20.3%对 27.1%,P=0.012 和 P=0.015)和 ET 的 LBR(23.0%对 29.7%,P=0.022 和 P=0.025)。在纳入新鲜和冷冻-解冻转移后,LBR 的差异仍然显著(均为粗观和年龄调整数据):OPU 的 LBR(26.1%对 34.4%,P=0.005 和 P=0.006)和 ET 的 LBR(28.3%对 37.1%,P=0.006 和 P=0.006)。与对照组相比,单侧卵巢切除女性的原始取消率显著更高(18.9%对 14.5%,P=0.034 和年龄调整后,P=0.178)。在多变量 GEE 模型中,新鲜和冷冻-解冻转移后 LBR(OPU)的累积优势比(OR)为 0.70(95%CI 0.52-0.94,P=0.016)和 LBR(ET)(OR 0.68,95%CI 0.51-0.92,P=0.012)大约降低了 30%,调整了年龄、BMI、生殖中心、周期和适当的胚胎移植数量。单侧卵巢切除女性的 OSI 明显低于对照组(3.6 对 6.0),并且无论在粗观还是年龄调整数据中,差异均具有统计学意义(均 P<0.001)。单侧卵巢切除女性的卵母细胞采集量明显少于对照组(7.2 对 9.9,P<0.001)。

局限性、谨慎原因:由于主题的性质,这是一项回顾性分析,存在所有固有的局限性。此外,无法在所有情况下获得单侧卵巢切除的原因。单侧卵巢切除组的子宫内膜异位症诊断也更为常见,因此不能完全排除单侧卵巢切除组患者特征较差的选择偏倚。然而,对所有已知混杂因素的调整并未影响总体结果。

更广泛的影响

迄今为止,这是最大的队列研究,也是第一个表明单侧卵巢切除史与 IVF/ICSI 后活产率降低相关的研究。这些发现是新颖的,与之前认为 IVF/ICSI 治疗不受单侧卵巢切除影响或仅受轻微影响的观点相矛盾。

研究资金/利益冲突:无。

试验注册编号

不适用。

相似文献

1
Reduced live-birth rates after IVF/ICSI in women with previous unilateral oophorectomy: results of a multicentre cohort study.单侧卵巢切除术后行 IVF/ICSI 妇女活产率降低:一项多中心队列研究结果。
Hum Reprod. 2018 Feb 1;33(2):238-247. doi: 10.1093/humrep/dex358.
2
Conventional ovarian stimulation and single embryo transfer for IVF/ICSI. How many oocytes do we need to maximize cumulative live birth rates after utilization of all fresh and frozen embryos?体外受精/卵胞浆内单精子注射的传统卵巢刺激和单胚胎移植。在利用所有新鲜和冷冻胚胎后,我们需要多少个卵母细胞才能使累积活产率最大化?
Hum Reprod. 2016 Feb;31(2):370-6. doi: 10.1093/humrep/dev316. Epub 2016 Jan 2.
3
Cumulative live birth rates after one ART cycle including all subsequent frozen-thaw cycles in 1050 women: secondary outcome of an RCT comparing GnRH-antagonist and GnRH-agonist protocols.1050名女性在一个辅助生殖技术周期(包括所有后续冻融周期)后的累积活产率:一项比较促性腺激素释放激素拮抗剂和促性腺激素释放激素激动剂方案的随机对照试验的次要结果。
Hum Reprod. 2017 Mar 1;32(3):556-567. doi: 10.1093/humrep/dew358.
4
Modified natural cycle versus controlled ovarian hyperstimulation IVF: a cost-effectiveness evaluation of three simulated treatment scenarios.改良自然周期与控制性卵巢过度刺激 IVF:三种模拟治疗方案的成本效益评估。
Hum Reprod. 2013 Dec;28(12):3236-46. doi: 10.1093/humrep/det386. Epub 2013 Oct 27.
5
The role of intracytoplasmic sperm injection in non-male factor infertility in advanced maternal age.胞浆内单精子注射在高龄产妇非男性因素不孕中的作用。
Hum Reprod. 2017 Jan;32(1):119-124. doi: 10.1093/humrep/dew298. Epub 2016 Nov 16.
6
Endometriosis and cumulative live birth rate after fresh and frozen IVF cycles with single embryo transfer in young women: no impact beyond reduced ovarian sensitivity-a case control study.内异症及单次胚胎移植新鲜和冻融 IVF 周期对年轻妇女累积活产率的影响:降低卵巢反应性以外无影响——一项病例对照研究。
J Assist Reprod Genet. 2019 Aug;36(8):1649-1656. doi: 10.1007/s10815-019-01519-5. Epub 2019 Jul 16.
7
The effect of type of oral contraceptive pill and duration of use on fresh and cumulative live birth rates in IVF/ICSI cycles.口服避孕药类型和使用时间对 IVF/ICSI 周期中新鲜和累积活产率的影响。
Hum Reprod. 2020 Apr 28;35(4):826-836. doi: 10.1093/humrep/dez299.
8
Factors affecting the outcome of frozen-thawed embryo transfer.影响冻融胚胎移植结局的因素。
Hum Reprod. 2013 Sep;28(9):2425-31. doi: 10.1093/humrep/det251. Epub 2013 Jun 11.
9
Population trends and live birth rates associated with common ART treatment strategies.与常见辅助生殖技术(ART)治疗策略相关的人口趋势和活产率
Hum Reprod. 2016 Nov;31(11):2632-2641. doi: 10.1093/humrep/dew232. Epub 2016 Sep 22.
10
Impact of letrozole co-treatment during ovarian stimulation on oocyte yield, embryo development, and live birth rate in women with normal ovarian reserve: secondary outcomes from the RIOT trial.在卵巢刺激过程中联合使用来曲唑对卵巢储备功能正常女性的卵母细胞产量、胚胎发育及活产率的影响:RIOT试验的次要结果
Hum Reprod. 2023 Nov 2;38(11):2154-2165. doi: 10.1093/humrep/dead182.

引用本文的文献

1
Combined Pharmacological and surgical treatments for recurrent chemical peritonitis due to rupture of a bilateral mature cystic teratoma: a case report.双侧成熟囊性畸胎瘤破裂所致复发性化学性腹膜炎的药物与手术联合治疗:一例报告
BMC Womens Health. 2025 Apr 11;25(1):172. doi: 10.1186/s12905-025-03719-x.
2
In Vitro Maturation, In Vitro Oogenesis, and Ovarian Longevity.体外成熟、体外卵母细胞发生和卵巢寿命。
Reprod Sci. 2024 May;31(5):1234-1245. doi: 10.1007/s43032-023-01427-1. Epub 2023 Dec 30.
3
A Rare Ovarian Tumor: The Sclerosing Stromal You Do Not Expect-A Case Series in the Adolescent Population and a Literature Review.
一种罕见的卵巢肿瘤:硬化性间质瘤——青少年人群中的病例系列及文献综述
Pediatr Rep. 2023 Jan 5;15(1):20-32. doi: 10.3390/pediatric15010004.
4
Missed opportunities for ovarian salvage in children: an 8-year review of surgically managed ovarian lesions at a tertiary pediatric surgery centre.儿童卵巢挽救机会的错失:三级儿科手术中心 8 年手术治疗卵巢病变的回顾性研究。
Pediatr Surg Int. 2021 Sep;37(9):1281-1286. doi: 10.1007/s00383-021-04935-w. Epub 2021 Jul 7.
5
Live Birth Rate Comparison Between Single vs. Double Ovary Women With Assisted Reproduction: A Single Tertiary Center Study.单卵巢与双卵巢女性辅助生殖的活产率比较:一项单中心三级研究
Cureus. 2021 May 6;13(5):e14876. doi: 10.7759/cureus.14876.
6
Live births after in vitro maturation of oocytes in women who had suffered adnexal torsion and unilateral oophorectomy following conventional ovarian stimulation.因常规卵巢刺激后发生附件扭转和单侧卵巢切除而接受体外成熟卵母细胞培养的妇女的活产。
J Assist Reprod Genet. 2021 Jun;38(6):1323-1329. doi: 10.1007/s10815-021-02171-8. Epub 2021 Apr 7.
7
Biological Impact of Unilateral Oophorectomy: Does the Number of Ovaries Really Matter?单侧卵巢切除术的生物学影响:卵巢数量真的重要吗?
Geburtshilfe Frauenheilkd. 2021 Mar;81(3):331-338. doi: 10.1055/a-1239-3958. Epub 2020 Oct 1.
8
Endometriosis and cumulative live birth rate after fresh and frozen IVF cycles with single embryo transfer in young women: no impact beyond reduced ovarian sensitivity-a case control study.内异症及单次胚胎移植新鲜和冻融 IVF 周期对年轻妇女累积活产率的影响:降低卵巢反应性以外无影响——一项病例对照研究。
J Assist Reprod Genet. 2019 Aug;36(8):1649-1656. doi: 10.1007/s10815-019-01519-5. Epub 2019 Jul 16.
9
Cryopreservation and transplantation of ovarian tissue: results from one center in the USA.卵巢组织的冷冻保存和移植:来自美国一个中心的结果。
J Assist Reprod Genet. 2018 Dec;35(12):2205-2213. doi: 10.1007/s10815-018-1315-1. Epub 2018 Sep 25.