The First Hospital of Lanzhou University, Lanzhou, China.
Key Laboratory for Reproductive Medicine and Embryo, Gansu Province, Lanzhou, China.
Medicine (Baltimore). 2022 Aug 26;101(34):e30166. doi: 10.1097/MD.0000000000030166.
Early pregnancy loss (EPL) is a common complication of assisted reproductive technology treatment; however, the exact factors involved in EPL are not fully understood. This study aimed to evaluate the risk factors for EPL in fresh in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) cycles. This retrospective cohort study was conducted on all couples who underwent clinical pregnancy in fresh IVF/ICSI cycles from January to December 2019 at a single large reproductive medical center. In total, 954 cycles were included in this study. Univariate and multivariate logistic regression analyses were performed to evaluate relevant risk factors for EPL. Curve fitting and threshold analyses were used to explore the association between risk factors and EPL. Compared with women with a normal total antral follicle count (AFC) (≥10, <15), those with a low AFC (<10) had a higher risk of EPL (odds ratio 2.97, 95% confidence interval: 1.38-6.38, P < .05). Patients with an estradiol/progesterone ratio (E2/P) ≥ 1.1 had significantly lower odds of EPL than women with E2/P < 1.1 (odds ratio 0.51, 95% confidence interval 0.28-0.91, P < .05). E2/P and serum human chorionic gonadotropin (hCG) levels negatively correlated with EPL. By using a 2-piecewise regression model, the inflection point of serum hCG level was 599.9 IU/L. Our results showed that lower AFC, E2/P, and serum hCG levels were associated with a higher EPL risk in fresh IVF/ICSI cycles.
早期妊娠丢失（EPL）是辅助生殖技术治疗的常见并发症；然而，EPL 的确切相关因素尚未完全阐明。本研究旨在评估新鲜体外受精（IVF）或卵胞浆内单精子注射（ICSI）周期中 EPL 的风险因素。这是一项回顾性队列研究，纳入了 2019 年 1 月至 12 月在一家大型生殖医学中心接受新鲜 IVF/ICSI 周期临床妊娠的所有夫妇。共有 954 个周期纳入本研究。采用单变量和多变量逻辑回归分析评估 EPL 的相关风险因素。采用曲线拟合和阈值分析探讨风险因素与 EPL 的关系。与正常总窦卵泡计数（AFC）（≥10，<15）的女性相比，AFC 较低（<10）的女性 EPL 风险更高（优势比 2.97，95%置信区间：1.38-6.38，P<.05）。E2/P≥1.1 的患者 EPL 发生率明显低于 E2/P<1.1 的患者（优势比 0.51，95%置信区间 0.28-0.91，P<.05）。E2/P 和血清人绒毛膜促性腺激素（hCG）水平与 EPL 呈负相关。使用 2 段回归模型，血清 hCG 水平的拐点为 599.9 IU/L。研究结果表明，较低的 AFC、E2/P 和血清 hCG 水平与新鲜 IVF/ICSI 周期中较高的 EPL 风险相关。
