国际生殖健康/计划生育杂志

国际生殖健康/计划生育 ›› 2019, Vol. 38 ›› Issue (1): 20-25.

• 论著 • 上一篇    下一篇

多囊卵巢综合征患者血清维生素D水平与IVF/ICSI-ET妊娠结局的关系

万彦伶，郝翠芳   

  1. 266000 青岛大学医学部（万彦伶）；青岛大学附属烟台毓璜顶医院生殖医学科（郝翠芳）
  • 收稿日期:2018-10-09 修回日期:2018-11-19 出版日期:2019-01-15 发布日期:2019-01-15
  • 通讯作者: 郝翠芳，E-mail：cuifang-hao@163.com E-mail:cuifang-hao@163.com
  • 基金资助:
    国家自然科学基金（81671416）

The Level of Serum Vitamin D and the Pregnancy Outcome of In-Vitro Fertilization/Intracytoplasmic Sperm Injection-Embryo Transplantation in Women with Polycystic Ovary Syndrome

WAN Yan-ling, HAO Cui-fang   

  1. Medical College of Qingdao University, Qingdao 266000, Shandong Province, China（ＷAN Yan-linｇ）；Center for Reproductive Medicine, The Affiliated Yantai Yuhuangding Hospital of Qingdao University,Yantai 264000, Shandong Province, Chinａ（HAO Cui-fanｇ）
  • Received:2018-10-09 Revised:2018-11-19 Published:2019-01-15 Online:2019-01-15
  • Contact: HAO Cui-fang，E-mail：cuifang-hao@163.com E-mail:cuifang-hao@163.com

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摘要： 目的：探讨多囊卵巢综合征（polycystic ovary syndrome，PCOS）患者血清维生素D水平与体外受精/胞浆内单精子注射（in-vitro fertilization/intracytoplasmic sperm injection，IVF/ICSI）治疗结局的关系。方法：回顾性分析2016年11月—2018年6月青岛大学附属烟台毓璜顶医院IVF/ICSI治疗的PCOS患者共286例，其中新鲜周期移植患者114例，根据患者血清25羟维生素D（25OHD）水平分为维生素D缺乏组（≤10 ng/mL）、不足组（10～30 ng/mL）和充足组（≥30 ng/mL），比较3组IVF/ICSI妊娠结局。新鲜周期移植患者按照临床妊娠结局分为临床妊娠组和未妊娠组，分析影响临床妊娠的因素；排除共线性，并校正年龄、基础黄体生成激素、基础睾酮水平、移植日子宫内膜厚度等混杂因素后，对血清维生素D水平与新鲜周期移植患者临床妊娠结局进行Logistic逐步回归分析。结果：（1）维生素D缺乏组、不足组及充足组间体质量指数（BMI）、基础睾酮、基础黄体生成激素/基础卵泡刺激素差异有统计学意义（P＜0.05），3组间促排卵治疗指标差异均无统计学意义（P＞0.05）。（2）新鲜周期移植患者维生素D缺乏组、不足组及充足组间BMI差异有统计学意义，维生素D缺乏组BMI高于维生素D不足组（P＜0.05）；3组间移植胚胎数差异无统计学意义（P＞0.05），受精率及胚胎种植率差异有统计学意义（P＜0.01）。（3）临床妊娠组患者基础黄体生成激素及基础睾酮水平低于未妊娠组（P＜0.05）；临床妊娠组移植日子宫内膜厚度及受精率均高于未妊娠组（P＜0.05）。Logistic逐步回归分析显示，与血清维生素D缺乏组相比，不足组及充足组IVF/ICSI-ET临床妊娠率均升高（不足组：aOR=5.559，95%CI：1.463～21.124，P=0.012；充足组：aOR=11.192，95%CI：1.674～74.822，P=0.013）。结论：血清维生素D水平≥10 ng/mL是PCOS不孕女性IVF/ICSI-ET临床妊娠的保护因素。

关键词: 维生素D, 多囊卵巢综合征, 受精, 体外, 精子注射, 细胞质内, 妊娠结局

Abstract: Objective：To investigate the correlation between serum vitamin D and the pregnancy outcome of in-vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) in women with polycystic ovary syndrome (PCOS). Methods: A total of 286 infertility women with PCOS underwent IVF/ICSI from November 2016 to June 2018 were included，including 114 women received fresh embryo transfer (ET). According to the level of 25-hydroxyvitamin D(25OHD), those patients were divided into three groups: vitamin D deficiency group (≤10 ng/mL), insufficiency group (10-30 ng/mL) and sufficiency group (≥30 ng/mL).The pregnancy rate of IVF/ICSI was analyzed. Furthermore, the patients with fresh ET were further divided into two groups: clinical pregnancy group and non-pregnancy group. After adjusting for baselines of luteinizing hormone (LH), testosterone and endometrial thickness on the ET day, logistic regression analysis on the vitamin D level and clinical pregnancy outcome of IVF/ICSI-ET was performed. Results: (1)There were significant differences in BMI, baseline testosterone, the ratio of baseline LH/FSH among three groups (P＜0.05). There were no significant differences in the indicators of ovulation induction (P＞0.05). (2)In those fresh ET patients, there were significant differences in BMI, the rate of fertilization and the rate of embryo implantation among three subgroups (P＜0.05). (3) The baselines of LH and testosterone in the pregnancy group were lower than those in the non-pregnancy group (P＜0.05), while the endometrial thickness on the ET day and the rate of fertilization in the pregnancy group were significantly higher than those in the non-pregnancy group (P＜0.05). After adjusting for age, baseline LH, baseline testosterone, the endometrial thickness on the ET day and the ratio of baseline LH/FSH, the logistic regression analysis showed that the pregnancy rates in the vitamin D insufficiency group and the sufficiency group were significantly higher than this rate in the vitamin D deficiency group （aOR=5.559，95%CI：1.463-21.124，P=0.012；aOR=11.192，95%CI：1.674-74.822，P=0.013）. Conclusions: The level of serum vitamin D≥10 ng/mL is a protective factor of IVF/ICSI-ET in women with PCOS.

Key words: Vitamin D；Polycystic ovary syndrome, Fertilization in vitro, Sperm injections, intracytoplasmic, Pregnancy outcome

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