Division of Women's Health, Faculty of Life Sciences and Medicine, King's College London, London, UK.
Department of Reproductive Medicine, Christian Medical College, Vellore, India.
Hum Reprod. 2021 Feb 18;36(3):676-682. doi: 10.1093/humrep/deaa283.
Does the cause of infertility affect the perinatal outcomes preterm birth (PTB) and low birth weight (LBW) following IVF treatment?
The risk of PTB and LBW was higher with female causes of infertility-ovulatory disorders, tubal disorders and endometriosis-compared to unexplained infertility but the absolute increase in risk was low.
Infertility is associated with an increased risk of adverse perinatal outcomes. Risk of adverse perinatal outcomes is also higher following ART compared to spontaneous conceptions. Infertility can result from female and/or male factors or is unexplained when the cause cannot be delineated by standard investigations. Given that infertility and ART are contributory to the adverse perinatal outcomes, it is a matter of interest to delineate if the specific cause of infertility influences perinatal outcomes following IVF treatment.
STUDY DESIGN, SIZE, DURATION: Anonymous data were obtained from the Human Fertilization and Embryology Authority (HFEA). The HFEA has collected data prospectively on all ART cycles performed in the UK since 1991. Data from 1991 to 2016 comprising a total of 117 401 singleton live births following IVF with or without ICSI (IVF ± ICSI) for sole causes of infertility were analysed for PTB and LBW. Cycles having more than one cause of infertility and/or multiple births were excluded.
PARTICIPANTS/MATERIALS, SETTING, METHODS: Data on all women undergoing stimulated IVF ± ICSI treatment cycles were analysed to compare perinatal outcomes of PTB and LBW among singleton live births based on the cause of infertility (ovulatory disorders, tubal disorders, endometriosis, male factor, unexplained). Logistic regression analysis was performed, adjusting for female age category, period of treatment, previous live births, IVF or ICSI, number of embryos transferred and fresh or frozen embryo transfer cycles.
Compared to unexplained infertility, the risk of PTB was significantly higher with ovulatory disorders (adjusted odds ratio (aOR) 1.31, 99.5% CI 1.17 to 1.46); tubal disorders (aOR 1.25, 99.5% CI 1.14 to 1.38) and endometriosis (aOR 1.17, 99.5% CI 1.01 to 1.35). There was no significant difference in the risk of PTB with male factor causes compared to unexplained infertility (aOR 1.01, 99.5% CI 0.93, 1.10). The risk of LBW was significantly higher with ovulatory disorders (aOR 1. 29, 99.5% CI 1.16 to 1.44) and tubal disorders (aOR 1.12, 99.5% CI 1.02 to 1.23) and there was no increase in the risk of LBW with endometriosis (aOR 1.11, 99.5% CI 0.96 to 1.30) and male factor causes (aOR 0.94, 99.5% CI 0.87, 1.03), compared to unexplained infertility.
LIMITATIONS, REASONS FOR CAUTION: Although the analysis was adjusted for several important confounders, there was no information on the medical history of women during pregnancy to allow adjustment. The limitations with observational data would apply to this study, including residual confounding.
This is the largest study to address the causes of infertility affecting perinatal outcomes of PTB and LBW. The information is important for the management of pregnancies and the underlying reasons for the associations observed need to be further understood.
STUDY FUNDING/COMPETING INTEREST(S): No funding was obtained. There are no competing interests to declare.
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不孕的原因是否会影响试管婴儿治疗后的早产（PTB）和低出生体重（LBW）等围产期结局？
与不明原因的不孕相比，女性不孕原因（排卵障碍、输卵管疾病和子宫内膜异位症）与 PTB 和 LBW 的风险更高，但风险的绝对增加幅度较低。
不孕与不良围产期结局的风险增加有关。与自然受孕相比，ART 后不良围产期结局的风险更高。不孕可能由女性和/或男性因素引起，或者在无法通过标准检查确定原因时被认为是不明原因的。鉴于不孕和 ART 是不良围产期结局的促成因素，因此需要阐明不孕的具体原因是否会影响试管婴儿治疗后的围产期结局。
研究设计、规模、持续时间：匿名数据来自人类受精和胚胎管理局（HFEA）。自 1991 年以来，HFEA 一直在英国前瞻性地收集所有 ART 周期的数据。分析了 1991 年至 2016 年期间总共 117401 例因单一原因不孕而接受 IVF 加或不加 ICSI（IVF ± ICSI）的单胎活产儿的早产和低出生体重。排除了具有多种不孕原因和/或多胎的周期。
参与者/材料、设置、方法：分析了所有接受促排卵 IVF ± ICSI 治疗周期的女性的数据，根据不孕的原因（排卵障碍、输卵管疾病、子宫内膜异位症、男性因素、不明原因）比较了单胎活产儿的早产和低出生体重的围产期结局。采用 logistic 回归分析，调整了女性年龄类别、治疗期间、既往活产、IVF 或 ICSI、移植胚胎数量以及新鲜或冷冻胚胎移植周期等因素。
与不明原因的不孕相比，排卵障碍（调整后的优势比（aOR）1.31，99.5%CI 1.17 至 1.46）、输卵管疾病（aOR 1.25，99.5%CI 1.14 至 1.38）和子宫内膜异位症（aOR 1.17，99.5%CI 1.01 至 1.35）的 PTB 风险显著更高。与不明原因的不孕相比，男性因素引起的 PTB 风险无显著差异（aOR 1.01，99.5%CI 0.93 至 1.10）。排卵障碍（aOR 1.29，99.5%CI 1.16 至 1.44）和输卵管疾病（aOR 1.12，99.5%CI 1.02 至 1.23）的 LBW 风险显著更高，而子宫内膜异位症（aOR 1.11，99.5%CI 0.96 至 1.30）和男性因素引起的 LBW 风险无显著增加（aOR 0.94，99.5%CI 0.87 至 1.03），与不明原因的不孕相比。
局限性、谨慎的原因：尽管该分析调整了几个重要的混杂因素，但没有关于孕妇怀孕期间病史的信息，无法进行调整。观察性数据的局限性也适用于本研究，包括残留混杂。
这是研究不孕原因对试管婴儿治疗后早产和低出生体重等围产期结局影响的最大研究。这些信息对于妊娠管理很重要，需要进一步了解观察到的关联的根本原因。
研究资金/利益冲突：未获得资金。没有竞争利益需要申报。
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