体质量指数对卵巢正常反应患者累积分娩率的影响

doi:10.6040/j.issn.1671-7554.0.2024.0145

摘要/Abstract

摘要： 目的比较不同体质量指数(body mass index, BMI)对卵巢正常反应患者行体外受精或卵胞浆内单精子注射(in vitro fertilization/intracytoplasmic sperm microinjection, IVF/ICSI)治疗单个取卵周期胚胎移植累积分娩率(cumulative birth rate, CLBR)的影响。方法回顾性分析行IVF/ICSI治疗的3 227个取卵周期,根据BMI分为偏瘦组(BMI<18.5,167个)、正常体质量组(18.5≤BMI<24.0,2024个)、超重组(24.0≤BMI<28.0,816个)、肥胖组(BMI≥28.0,220个)。分别比较各组患者的临床特征、实验室指标及助孕结局。结果 4组患者随BMI升高,促性腺激素(gonadotrophin, Gn)总量逐渐增加,各组间差异均有统计学意义(P<0.001);各组间患者获卵数、优胚数、2PN受精率、2PN卵裂率差异均无统计学意义(P>0.05)。肥胖组的优胚率、囊胚形成率均低于正常体质量组(P=0.012, P<0.001)和超重组(P=0.014, P<0.001)。超重组与肥胖组的卵子利用率均低于正常体质量组患者(P=0.031, P=0.002)。超重组的流产率高于正常体质量组(P=0.013)。超重组和肥胖组的CLBR均低于正常体质量组(P=0.009, P=0.023)。各组间患者的临床妊娠率、早产率差异均无统计学意义(P>0.05)。BMI和CLBR具有显著负相关性,调整后的OR(95%CI)为0.953(0.948~0.958)。结论在进行辅助生殖技术助孕的卵巢正常反应人群中,超重及肥胖导致Gn使用量增加,且肥胖患者的优胚率、囊胚形成率、卵子利用率、取卵周期CLBR明显降低,提示超重肥胖患者积极减重后再进行辅助生殖治疗。

关键词: 体质量指数, 累积分娩率, 体外受精-胚胎移植, 肥胖

Abstract: Objective To compare the effects of different body mass index(BMI)on the cumulative birth rate(CLBR)in patients with normal ovarian response undergoing in vitro fertilization/intracytoplasmic sperm microinjection(IVF/ICSI). Methods A retrospective analysis of 3,227 oocyte retrieval cycles treated with IVF/ICSI was performed. Patients were divided into low BMI group(BMI<18.5, n=167), normal BMI group(18.5≤BMI<24.0, n=2,024), overweight group(24.0≤BMI<28.0, n=816), and obese group(BMI≥28.0, n=220). Clinical characteristics, laboratory indicators and pregnancy outcomes were compared among the groups. Results The total amount of gonadotrophin(Gn)elevated with increasing BMI in all four groups, with significant difference(P<0.001). There were no significant differences in the number of oocytes, number of high-quality embryos, 2PN fertilization rate, and 2PN cleavage rate among the four groups(P>0.05). The high-quality embryo rate and blastocyst formation rate in the obese group were lower than those in the normal BMI group(P=0.012, P<0.001)and overweight group(P=0.014, P<0.001). Oocyte utilization was significantly lower in the overweight and obese groups than in the normal BMI group(P=0.031, P=0.002). The miscarriage rate was higher in the overweight group than in the normal BMI group(P=0.013). CLBR was lower in the obese and overweight groups than in the normal BMI group(P=0.009, P=0.023). There were no significant differences in the clinical pregnancy rate and preterm labor rate among the four groups(P>0.05). Higher BMI was significantly associated with lower CLBR, and an adjusted OR(95%CI)was 0.953(0.948-0.958). Conclusion In patients with normal ovarian response undergoing assisted reproductive technology, overweight and obesity lead to increased total dosage of Gn, and the high-quality embryo rate, blastocyst formation rate, oocyte utilization rate and CLBR are significantly lower in obese patients, indicating that such patients should undergo aggressive weight loss before proceeding to assisted reproduction therapy.

Key words: Body mass index, Cumulative birth rate, In vitro fertilization-embryo transfer, Obesity

中图分类号:

R711.6

刘雯,冯文娟,杨阳,纪昌丽,晁岚. 体质量指数对卵巢正常反应患者累积分娩率的影响[J]. 山东大学学报 (医学版), 2024, 62(3): 54-60.

LIU Wen, FENG Wenjuan, YANG Yang, JI Changli, CHAO Lan. Impact of BMI on cumulative birth rate in patients with normal ovarian response[J]. Journal of Shandong University (Health Sciences), 2024, 62(3): 54-60.

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