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影响体外受精成功率的术前及术中因素:评估输卵管因素不孕症病例中的胚胎质量和临床妊娠情况

Pre- and Procedural Factors Influencing the Success of In Vitro Fertilization: Evaluating Embryo Quality and Clinical Pregnancy in Cases of Tubal Factor Infertility.

作者信息

Kozinszky Zoltan, Bereczki Kristóf, Vedelek Viktor, Bicskei Petra, Tabi Mariann, Ekes Csaba, Lajkó Noémi, Nagy Olga, Sinka Rita, Vágvölgyi Anna, Zádori János

机构信息

Capio Specialized Center for Gynecology, Solna, 182 88 Stockholm, Sweden.

Department of Obstetrics and Gynecology, Albert Szent-Gyorgyi Medical School, University of Szeged, 6725 Szeged, Hungary.

出版信息

J Clin Med. 2024 Sep 27;13(19):5754. doi: 10.3390/jcm13195754.

DOI:10.3390/jcm13195754
PMID:39407814
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11476437/
Abstract

: While tubal occlusion is a prevalent cause of infertility, accounting for 11-35% of infertility cases among women, there remains a limited understanding of the factors influencing clinical pregnancy following in vitro fertilization (IVF). : In our retrospective, cross-sectional cohort study conducted at a single tertiary center, medical records of women aged 19 to 43 years were analyzed. Logistic regression models were employed to identify the prognostic factors associated with clinical pregnancy after IVF in patients with tubal factor infertility, excluding cases with hydrosalpinx. : Data from 219 women diagnosed with tubal occlusion were compared to 1140 cases with non-tubal indication, covering a total of 1359 IVF cycles. A lower maternal age (adjusted odds ratio [AOR]: 0.89, = 0.001) and a higher embryo quality (AOR: 1.26, = 0.01) emerged as important factors in clinical pregnancy in the tubal infertility group. Moreover, a lower maternal (AOR:0.91, < 0.01) and paternal age ( = 0.001), and favorable semen quality (AOR: 1.32, = 0.03) were critical determinants in the non-tubal infertility group. BMI was generally higher in tubal infertility patients ( = 0.01). Furthermore, FSH level (AOR: 0.93, = 0.004), AMH level ( < 0.04), number of embryos transferred (AOR: 2.04, < 0.001), and embryo quality (AOR: 1.26, < 0.001) came into prominence only in the non-tubal infertility group. The clinical pregnancy rate (34.2%) of women with tubal occlusion did not differ significantly from those in other forms of infertility undergoing IVF (35.4%). : Although tubal infertility is typically anticipated to yield the highest clinical pregnancy rates following IVF, it is crucial to acknowledge that both maternal and paternal characteristics can also significantly impact the outcomes.

摘要

输卵管阻塞是不孕症的常见原因,占女性不孕症病例的11%-35%,但对于体外受精(IVF)后影响临床妊娠的因素仍了解有限。在我们于单一三级中心进行的回顾性横断面队列研究中,分析了19至43岁女性的医疗记录。采用逻辑回归模型来确定输卵管因素不孕症患者IVF后与临床妊娠相关的预后因素,排除输卵管积水病例。将219例诊断为输卵管阻塞的女性数据与1140例非输卵管指征病例进行比较,共涵盖1359个IVF周期。较低的母亲年龄(调整优势比[AOR]:0.89,P = 0.001)和较高的胚胎质量(AOR:1.26,P = 0.01)是输卵管不孕症组临床妊娠的重要因素。此外,较低的母亲年龄(AOR:0.91,P < 0.01)和父亲年龄(P = 0.001)以及良好的精液质量(AOR:1.32,P = 0.03)是非输卵管不孕症组的关键决定因素。输卵管不孕症患者的BMI普遍较高(P = 0.01)。此外,促卵泡生成素(FSH)水平(AOR:0.93,P = 0.004)、抗苗勒管激素(AMH)水平(P < 0.04)、移植胚胎数量(AOR:2.04,P < 0.001)和胚胎质量(AOR:1.26,P < 0.001)仅在非输卵管不孕症组中较为突出。输卵管阻塞女性的临床妊娠率(34.2%)与接受IVF的其他形式不孕症女性(35.4%)无显著差异。虽然通常预计输卵管不孕症在IVF后会产生最高的临床妊娠率,但必须认识到母亲和父亲的特征也会对结果产生重大影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb0e/11476437/5b3080c2955b/jcm-13-05754-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb0e/11476437/5b3080c2955b/jcm-13-05754-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/eb0e/11476437/5b3080c2955b/jcm-13-05754-g001.jpg

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本文引用的文献

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Front Endocrinol (Lausanne). 2024 Apr 26;15:1379109. doi: 10.3389/fendo.2024.1379109. eCollection 2024.
2
APHRODITE criteria: addressing male patients with hypogonadism and/or infertility owing to altered idiopathic testicular function.APHRODITE 标准:针对由于特发性睾丸功能改变而导致性腺功能减退和/或不育的男性患者。
Reprod Biomed Online. 2024 Apr;48(4):103647. doi: 10.1016/j.rbmo.2023.103647. Epub 2023 Oct 29.
3
Impact of the number of previous embryo implantation failures on IVF/ICSI-ET pregnancy outcomes in patients younger than 40 years: a retrospective cohort study.
既往胚胎种植失败次数对年龄<40 岁患者 IVF/ICSI-ET 妊娠结局的影响:一项回顾性队列研究。
Front Endocrinol (Lausanne). 2023 Sep 29;14:1243402. doi: 10.3389/fendo.2023.1243402. eCollection 2023.
4
Does maternal age affect assisted reproduction technology success rates after euploid embryo transfer? A systematic review and meta-analysis.母亲年龄是否会影响整倍体胚胎移植后辅助生殖技术的成功率?系统评价和荟萃分析。
Fertil Steril. 2023 Aug;120(2):251-265. doi: 10.1016/j.fertnstert.2023.02.036. Epub 2023 Mar 5.
5
IVF outcomes following ICSI cycles using testicular sperm in obstructive (OA) vs. non-obstructive azoospermia (NOA) and the impact of maternal and paternal age: a SART CORS data registry.ICSI 周期中使用睾丸精子治疗梗阻性(OA)与非梗阻性无精子症(NOA)的 IVF 结局以及父母年龄的影响:SART CORS 数据注册。
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