从接受 IVF 的 PCOS 患者中获取的最佳卵母细胞数量与最大累积活产率和新鲜胚胎移植后的活产相关。

The Optimal Number of Oocytes Retrieved From PCOS Patients Receiving IVF to Obtain Associated With Maximum Cumulative Live Birth Rate and Live Birth After Fresh Embryo Transfer.

机构信息

Department of Reproductive Medicine, The Second Hospital of Hebei Medical University, Shijiazhuang, China.

出版信息

Front Endocrinol (Lausanne). 2022 Jun 23;13:878214. doi: 10.3389/fendo.2022.878214. eCollection 2022.

AIMS

This study aims to determine the optimal number of oocytes retrieved so that patients with polycystic ovary syndrome (PCOS) receiving fertilization (IVF) can obtain the best cumulative live birth rate (CLBR) and live birth after fresh embryo transfer.

METHODS

This is a retrospective study of 1,419 patients with PCOS who underwent their first IVF cycle at the Second Hospital of Hebei Medical University from January 2014 to December 2021. Multivariable regression analysis was performed to adjust for factors known to independently affect cumulative live birth aspiration. The number of oocytes retrieved to obtain the best cumulative live birth rate was explored through curve fitting and threshold effect analysis. The decision tree method was used to explore the best number of oocytes retrieved to achieve live birth in the shortest time.

RESULTS

(1) The number of oocytes retrieved was found to be an independent protective factor for the cumulative live birth rate (OR = 1.09 (95% CI: 1.06, 1.12)). When the number of oocytes retrieved was less than 15, CLBR increased by 16% with each increase in the number of oocytes retrieved (OR = 1.16 (95% CI: 1.11, 1.22)); and when more than 15, CLBR tended to be stable. (2) Live birth after the first fresh embryo transfer was analyzed through a classification decision tree. For patients younger than 35 years old, those with less than 6 oocytes and those with 7-16 oocytes had a similar proportion of live births with fresh embryo transfer but higher than 16 oocytes (53.7% vs. 53.8% vs. 18.4%). Patients older than 35 years old had a similar proportion of live births with fresh embryo transfer (35.7% vs. 39.0%) to those younger than 35 years old, but the proportion of no live births after using up all embryos was higher than those younger than 35 years old (39.3% vs. 19.2%).

CONCLUSIONS

In PCOS patients, high CLBR can be obtained when the number of oocytes retrieved was 15 or more. The number of oocytes retrieved from 7 to 16 could achieve more chance of live birth after fresh embryo transfer.

目的

本研究旨在确定最佳取卵数量，使多囊卵巢综合征（PCOS）患者在接受体外受精（IVF）时能够获得最佳的累积活产率（CLBR）和新鲜胚胎移植后的活产率。

方法

这是一项回顾性研究，纳入了 2014 年 1 月至 2021 年 12 月在河北医科大学第二医院接受首次 IVF 周期的 1419 例 PCOS 患者。采用多变量回归分析调整已知独立影响累积活产率的因素。通过曲线拟合和阈值效应分析探讨获得最佳累积活产率的取卵数量。采用决策树方法探讨获得最短时间内活产的最佳取卵数量。

结果

（1）取卵数量被发现是累积活产率的独立保护因素（OR=1.09（95%CI：1.06，1.12））。当取卵数量小于 15 个时，CLBR 每增加一个取卵数量就会增加 16%（OR=1.16（95%CI：1.11，1.22））；而当取卵数量大于 15 个时，CLBR 趋于稳定。（2）通过分类决策树分析首次新鲜胚胎移植后的活产情况。对于年龄小于 35 岁的患者，取卵数小于 6 个和 7-16 个的患者的新鲜胚胎移植活产率相似，但高于 16 个（53.7%比 53.8%比 18.4%）。年龄大于 35 岁的患者的新鲜胚胎移植活产率与年龄小于 35 岁的患者相似（35.7%比 39.0%），但用尽所有胚胎后无活产的比例高于年龄小于 35 岁的患者（39.3%比 19.2%）。