【摘要】 目的探讨辅助生殖技术助孕后妊娠丢失的因素,寻找早期妊娠丢失与晚期妊娠丢失两者的差异。方法回顾性分析2013年1月～2019年12月在南方医科大学附属深圳妇幼保健院生殖医学中心接受胚胎移植周期的患者共4 523例,其中妊娠丢失组566例,同期分娩组3 957例。采用Kaplan-Meier法和Log-Rank检验评估两组患者一般情况、治疗周期情况与胚胎生存时间的关系,并进行COX回归分析。结果单因素分析显示:胚胎生存时间与女性年龄、男性年龄、女性体重指数(BMI)、不孕类型、受精方式、移植胚胎个数、自然减胎有显著相关性(P<0.05)。多因素分析发现,35岁以上的女性妊娠丢失的危险是35岁以下女性的2.883倍(OR=2.883,95%CI 2.443～3.417,P<0.001);卵胞浆内单精子显微注射(intracytoplasmic sperm injection, ICSI)助孕后女性发生妊娠丢失的危险比体外受精(in-vitro fertilization, IVF)女性增加了0.349倍(OR=1.349,95%CI 1.127～1.614,P<0.001);自然减胎发生妊娠丢失的风险增加了0.679倍(OR=1.679,95%CI 1.285～2.195,P<0.001)。囊胚移植后发生早期妊娠丢失的风险增加了0.307倍(OR=1.307,95%CI 1.030～1.658,P=0.028)。结论女性年龄、ICSI受精方式、自然减胎是IVF/ICSI胚胎移植助孕后妊娠丢失的独立因素。囊胚移植发生早期妊娠丢失的风险较卵裂期胚胎高。更多还原

【Abstract】 Objective To analyze the risk factors of pregnancy loss(PL) after treatment of assisted reproductive technology, and to explore the differences in specificity between early PL and late PL. Methods A retrospective study was launched in the Reproductive Medicine Center of Affiliated Shenzhen Maternity & Child Healthcare Hospital between Jan. 2013 and Dec. 2019, including 4 523 embryo transfer cycles with final pregnancy outcome(566 pregnancy loss and 3 957 live-birth). COX multivariate analysis was performed, while Kaplan-Meier method and Log-Rank test were used to evaluate the associations between the demographics, characteristics of the treatment cycle and gestational survival time of the two groups of patients. Results Compared with women ≤35 years old, those aged more than 35 years had significantly shorter survival pregnancy weeks(OR=2.883, 95% CI 2.443～3.417, P<0.001). Women received intracytoplasmic sperm microinjection(ICSI) tended to have higher risk of PL compared with the in vitro fertilization(IVF) group(OR=1.349, 95%CI 1.127～1.614, P<0.001). Women who were experienced an early spontaneous pregnancy reduction had a significantly increased risk of PL(OR=1.679, 95% CI 1.285～2.195, P<0.001). In addition, the blastocyst transfer cycle had been associated with a 30.7% increased risk of early PL(OR=1.307, 95% CI 1.030～1.658, P=0.028). Conclusion The age of the female, infertility type(ICSI) and an early spontaneous pregnancy reduction are independent factors. The risks of early PL during the blastocyst transfer cycle is higher than that of the cleavage stage.更多还原