摘要
目的 观察并分析经辅助生殖技术受孕的卵巢储备功能减退(DOR)患者的围生期结局。方法 选取2015年1月至2023年4月于湖州市妇幼保健院接受体外受精或卵胞质内单精子注射新鲜胚胎移植治疗,并单胎活产患者341例。其中DOR患者88例(DOR组),卵巢储备功能正常253例(对照组)。观察并比较两组患者一般资料和围生期结局指标,包括妊娠期高血压疾病(HDP)、妊娠期糖尿病(GDM)、前置胎盘、胎盘早剥、妊娠期肝内胆汁淤积症、早产、低出生体重儿等。因女性年龄对围生期结局有重大影响,以年龄35岁为临界值将每组患者分为2个亚组,观察并比较<35岁与≥35岁的两组患者围生期结局指标。分析患者发生HDP的危险因素。结果 两组患者年龄、BMI、催乳素、基础促黄体生成素、雌二醇、总睾酮、控制性卵巢刺激前收缩压、舒张压、总促性腺激素量及扳机日孕酮水平、子宫内膜厚度比较差异均无统计学意义(均P>0.05)。DOR组患者双侧窦卵泡计数、抗苗勒管激素水平、扳机日雌二醇均低于对照组,基础卵泡刺激素、孕酮水平均高于对照组,不孕因素有异于对照组,控制性卵巢刺激天数少于对照组,差异均有统计学意义(均P<0.05)。DOR组患者HDP发生率高于对照组(P<0.05)。两组患者GDM、前置胎盘、胎盘早剥、妊娠期肝内胆汁淤积症、早产、低出生体重儿发生率比较差异均无统计学意义(均P>0.05)。两组<35岁的患者围生期结局指标比较差异均无统计学意义(均P>0.05);≥35岁的患者中,DOR组HDP发生率高于对照组(P<0.05);其余围生期结局指标比较差异均无统计学意义(均P>0.05)。多因素修正Poisson回归分析显示,DOR是患者发生HDP的危险因素(RR=9.34,95%CI:1.71~51.02,P=0.010)。结论 与卵巢储备功能正常患者相比,经辅助生殖技术受孕的DOR患者HDP发生风险较大,围生期更需行缜密的产前检查。
Objective To explore whether women with diminished ovarian reserve(DOR) was associated with perinatal outcomes who were conceived by in-vitro fertilization/intracytoplasmic sperm injection cycles.Methods A retrospective cohort study including a total of 341 women who achieved singleton live birth after in vitro fertilization/intracytoplasmic sperm injection-fresh embryo transfer from January 2015 to April 2023 in Huzhou Maternity & Child Health Care Hospital.There were88 patients with DOR(DOR group) and 253 patients with normal ovarian reserve(control group).Baseline data and perinatal outcomes of the two groups were observed and compared,including hypertensive disorders during pregnancy(HDP),gestational diabetes mellitus(GDM),placenta previa,placental abruption,intrahepatic cholestasis during pregnancy,preterm birth,and low birth weight.Due to the significant influence of female age on perinatal outcomes,patients in each group were divided into two subgroups with the age of 35 years as the critical value,the perinatal outcomes of patients aged <35 years and ≥35 years were compared.The risk factors of HDP were analyzed.Results There were no significant differences between the two groups in age,body mass index,prolactin,baseline sex hormone including luteinizing hormone,estrodiol,total testosterone,systolic blood pressure and diastolic blood pressure before controlled ovarian stimulation,total gonadotropin dose,and progesterone and endometrial thickness on human chorionic gonadotropin trigger day(all P>0.05).The levels of bilateral antral follicle count,antimullerian hormone and estradiol level on human chorionic gonadotropin trigger day in DOR group were lower than those in the control group.The basal follicle-stimulating hormone and progesterone levels were higher than those of control group,the proportion of tubal factor infertility was lower than that of control group,and the controlled ovarian stimulation days were less than those of control group,the differences of which were all statistically significant(
作者
陈丽芬
梅丽娜
CHEN Lifen;MEI Lina(Department of Reproductive Medical Center,Huzhou Maternity&Child Health Care Hospital,Huzhou 313000,China)
出处
《浙江医学》
CAS
2024年第5期475-479,484,共6页
Zhejiang Medical Journal
基金
湖州市科学技术局公益性应用研究项目(2021GYB12)。
关键词
卵巢储备功能减退
妊娠期高血压疾病
围生期结局
体外受精
辅助生殖技术
Diminished ovarian reserve
Hypertensive disorders of pregnancy
Perinatal outcomes
In vitro fertilization
Assisted reproductive technology
