国际生殖健康/计划生育杂志

国际生殖健康/计划生育杂志 ›› 2024, Vol. 43 ›› Issue (1): 1-6.doi: 10.12280/gjszjk.20230221

• 论著 •    下一篇

高龄女性IVF/ICSI无可利用胚胎危险因素探讨

梁俊霞, 杨堉杰, 张丽(), 葛丽娜, 王娜娜, 田瑛, 刘鹏, 闫蒙   

  1. 050000 石家庄，河北省生殖健康医院生殖中心，河北省生殖医学重点实验室（梁俊霞，张丽，葛丽娜，王娜娜，田瑛），医学实验室（刘鹏），科技科（闫蒙）；华北理工大学医学院（杨堉杰）
  • 收稿日期:2023-05-30 出版日期:2024-01-15 发布日期:2024-01-31
  • 通讯作者: 张丽，E-mail: zhangli-sa@163.com
  • 基金资助:
    河北省医学科学研究课题计划(20210274);河北省“三三三人才工程”资助项目(A202002012)

Risk Factors of Unusable Embryos for IVF/ICSI in Older Women

LIANG Jun-xia, YANG Yu-jie, ZHANG Li(), GE Li-na, WANG Na-na, TIAN Ying, LIU Peng, YAN Meng   

  1. Reproductive Center, Key Laboratory of Reproductive Medicine of Hebei Province (LIANG Jun-xia, ZHANG Li, GE Li-na, WANG Na-na, TIAN Ying), Medical Laboratory (LIU Peng), Department of Science and Technology (YAN Meng), Hebei Reproductive Health Hospital, Shijiazhuang 050000, China; School of Medicine of North China University of Science and Technology, Tangshan 063210, Hebei Province, China (YANG Yu-jie)
  • Received:2023-05-30 Published:2024-01-15 Online:2024-01-31
  • Contact: ZHANG Li, E-mail: zhangli-sa@163.com

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摘要：

目的：探讨高龄女性体外受精（in vitro fertilization，IVF）/卵胞质内单精子注射（intracytoplasmic sperm injection，ICSI）周期取卵后无可利用胚胎的危险因素。方法：回顾性分析2015年1月—2021年12月在河北省生殖健康医院生殖中心行IVF/ICSI助孕的高龄女性共569个取卵周期，其中95个无可利用胚胎周期作为研究组，474个有可利用胚胎的周期作为对照组。2组女性按年龄分为3个亚组：35~39岁为G1组，40~42岁为G2组，43~45岁为G3组。比较各组患者的促排卵情况和实验室指标。结果：2组间相应年龄亚组患者的年龄、不孕年限、体质量指数（body mass index，BMI）、基础卵泡刺激素（follicle-stimulating hormone，FSH）、基础雌二醇（estradio，E2）、抗苗勒管激素（anti-Müllerian hormone，AMH）和启动日窦卵泡计数（antral follicle count，AFC）比较，差异均无统计学意义（均P>0.05）。2组扳机日黄体生成素（luteinizing hormone，LH）水平在G2亚组间比较，差异有统计学意义（P<0.05）；扳机日E2水平、卵泡输出率（follicular output rate，FORT）在G1、G2亚组间比较，差异有统计学意义（均P<0.05）；扳机日优势卵泡计数（preponderance follicle count，PFC）在3个亚组间比较，差异均有统计学意义（均P<0.05）；促性腺激素（gonadotropin，Gn）用量、Gn天数、扳机作用时间、扳机日孕酮（progesterone，P）水平和扳机日E2/PFC在3个亚组间比较，差异均无统计学意义（均P>0.05）。获卵数、MⅡ卵数、受精总数、卵裂总数、双原核（two pronuclei，2PN）数和2PN卵裂数在3个亚组间比较，差异均有统计学意义（均P<0.05）。Logistic回归分析显示，不孕年限是取卵后无可利用胚胎的危险因素，而扳机日PFC增加是保护因素。结论：高龄女性IVF/ICSI助孕中，随着不孕年限的增加，无可移植胚胎的发生率增加，而高PFC可能降低无可移植胚胎的发生风险。

关键词: 体外受精, 胚胎移植, 精子注射, 细胞质内, 无可利用胚胎, 危险因素

Abstract:

Objective: To investigate the risk factors of unusable embryos after egg retrieval in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in older women. Methods: A total of 569 egg retrieval cycles of older women who underwent IVF/ICSI assisted pregnancy in the Reproductive Center of Hebei Reproductive Health Hospital from January 2015 to December 2021 were retrospectively analyzed, including 95 cycles with unusable embryos as the study group and 474 cycles with usable embryos as the control group. According to the age, each group was divided into three subgroups: G1 group aged 35 to 39 years, G2 group aged 40 to 42 years, and G3 group aged 43 to 45 years. Ovulation induction and laboratory indexes were compared. Results: The differences of age, infertility years, body mass index (BMI), basic follicle-stimulating hormone (FSH), basic estradio (E2), anti-Müllerian hormone (AMH) and antral follicle count (AFC) on the start day in the corresponding subgroups between the two groups were not statistically significant (all P>0.05). There were significant differences in the level of luteinizing hormone (LH) on the trigger day between G2 subgroups (P<0.05). On the trigger day, the differences in the E2 level and follicular output rate (FORT) between G1 and G2 subgroups of both groups were statistically significant (all P<0.05). The differences of preponderance follicle count (PFC) on the trigger day among the three subgroups of both groups were statistically significant (P<0.05). There were no significant differences in gonadotropin (Gn) dosage, Gn days, trigger action time, trigger day progesterone (P) level and trigger day E2/PFC among 3 subgroups of both groups (all P>0.05). Meanwhile, the differences in the number of eggs obtained, the number of MⅡ eggs, the total number of fertilization, the total number of cleavage, the number of 2PN and the number of 2PN cleavage statistically significant (all P<0.05). Interestingly, Logistic regression analysis showed that the infertility year was a risk factor of unusable embryos after egg retrieval, while PFC on the trigger day was a protective factor. Conclusions: In IVF/ICSI assisted pregnancy for older women, the occurrence of non-transplantable embryos will increase with the increase of infertility years, while the increase of PFC on the trigger day will reduce the risk of non-transplantable embryos.

Key words: Fertilization in vitro, Embryo transfer, Sperm injections, intracytoplasmic, Unusable embryo, Risk factors