Analysis of Factors Affecting the Live-birth Rate after IVF-ET in Women with Diminished Ovarian Reserve:A Single-center Retrospective Cohort Study

【作者】 黄赟； 张丹；

【机构】 浙江大学医学院附属妇产科医院；

【摘要】 Objective:This study was carried out to investigate the impact factors of live-birth rate(LBR) in women with diminished ovarian reserve(DOR) undergoing in vitro fertilization and embryo transfer(IVF-ET).Methods:A total of 2277 cycles from 1957 diminished ovarian reserve women who underwent in vitro fertilization and embryo transfer(IVF-ET) cycles between January 2010 and December 2014 at Women’s Hospital,School of Medicine,Zhejiang University were retrospectively enrolled from our medical database.All the cycles were divided into live-birth(LB) group and non-live-birth(NLB) group according to live birth.Impact factors of live-birth rate were explored by Student’s t-test and Pearson’ chi-square test between the study groups.In subsequent analyses,we performed univariable and mixed-effects multivariate logistic regression analysis in order to assess if these impact factors remained unaltered after adjusting for potential confounders.Available information in the dataset included maternal factor(maternal age,age at menarche,body mass index,duration of infertility,antral follicle count,serum hormone levels and type of subfacility),paternal factor(paternal age,volume of sperm and the rate of progressive relativity(PR) in sperm),and IVF outcomes(type of ART,total gonadotropin dose,duration of stimulation,endometrial thickness on triggering day,number of follicles >14 mm,number of oocytes retrieved,embryo stage and the number of embryos transferred).All the clinical,laboratory and follow-up data were collected on the computerized database or by telephone interview.Informed consent was obtained from all patients.This retrospective cohort study was approved by the Institutional Review’ Board of Women’s Hospital,School of Medicine,Zhejiang University.Results:Among all the subjects,705 cases(31.0%) had clinical pregnancy,504 cases(22.1%) had live birth,47 cases(2.1%) had ectopic pregnancy,154 cases(6.8%) had miscarriage,while the other 1572 cases(69.0%) not having clinical pregnancy.After Student’s t-test and Pearson’ chi-square test between the live-birth(LB) group and non-live-birth(NLB) group(including ectopic pregnancy,miscarriage and cases not having clinical pregnancy),we demonstrated that the non-live-birth(NLB) group had statistically significant difference in maternal age(35.06±5.53 versus 32.61±4.70,P<0.001),duration of infertility(5.41±4.19 versus 4.67±3.45,P<0.001),female body mass index(22.31±2.87 versus 22.01±3.11,P=0.039),paternal age(36.78±6.16 versus 34.55±5.48,P<0.001),total gonadotropin(Gn) dose(2610.74±1097.89 versus 2494.07±819.95,P=0.010),endometrial thickness on day of hCG(10.38±2.17 versus 10.63±2.25,P=0.021),number of follicles >14 mm on triggering day(5.80±3.72 versus 6.31±3.20,P=0.007),number of oocytes retrieved(7.24±4.76 versus 8.30±4.42,P<0.001),embryo stage(P<0.001) and number of embryos transferred(2.04±0.74 versus 2.23±0.61,P<0.001) compared with the live-birth(LB) group.Moreover,there were not statistically significant differences between the study groups in age at menarche,antral follicle count(AFC),serum basal follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),progesterone(P) and testosterone(T) levels,the volume of sperm,the rate of progressive relativity(PR) in sperm,type of assisted reproductive technology(ART),type of subfertility,duration of stimulation,serum P and E2 levels on triggering day(P>0.05 respectively).In subsequent analyses,we performed univariable and mixed-effects multivariate logistic regression analysis in order to assess if these impact factors remained unaltered after adjusting for potential confounders.We found that female body mass index(adjusted odds ratio(aOR):1.01,95%CI:0.97-1.05;P=0.652),duration of infertility(aOR:0.98,95%CI:0.94-1.01;P=0.118),paternal age(aOR:0.99,95%CI:0.96-1.02;P=0.494),total gonadotropin dose(aOR:0.91,95%CI:0.83-1.00;P=0.059),endometrial thickness on day of hCG(aOR:1.05,95%CI:1.00-1.10;P=0.072),number of follicles >14 mm on triggering day(aOR:0.97,95%CI:0.93-1.02;P=0.220),and the number of oocytes retrieved(aOR:1.02,95%CI:0.99-1.06;P=0.217) no longer significantly affected the live-birth rate in DOR women undergoing IVF-ET after accounting for potential confounding.However,maternal age,embryo stage and the number of embryos transferred remained unaltered in the adjusted analysis.Hence,they were the independent impact factors affecting the IVF-ET live-birth rate in women with diminished ovarian reserve,although it is worth mentioning that the borderline off-value was 0.05 once more.Conclusions:Maternal age,embryo stage and the number of embryos transferred were the independent impact factors affecting the IVF-ET live-birth rate in women with diminished ovarian reserve(DOR) after adjusting for confounding variables.更多还原

【Abstract】 Objective:This study was carried out to investigate the impact factors of live-birth rate(LBR) in women with diminished ovarian reserve(DOR) undergoing in vitro fertilization and embryo transfer(IVF-ET).Methods:A total of 2277 cycles from 1957 diminished ovarian reserve women who underwent in vitro fertilization and embryo transfer(IVF-ET) cycles between January 2010 and December 2014 at Women’s Hospital,School of Medicine,Zhejiang University were retrospectively enrolled from our medical database.All the cycles were divided into live-birth(LB) group and non-live-birth(NLB) group according to live birth.Impact factors of live-birth rate were explored by Student’s t-test and Pearson’ chi-square test between the study groups.In subsequent analyses,we performed univariable and mixed-effects multivariate logistic regression analysis in order to assess if these impact factors remained unaltered after adjusting for potential confounders.Available information in the dataset included maternal factor(maternal age,age at menarche,body mass index,duration of infertility,antral follicle count,serum hormone levels and type of subfacility),paternal factor(paternal age,volume of sperm and the rate of progressive relativity(PR) in sperm),and IVF outcomes(type of ART,total gonadotropin dose,duration of stimulation,endometrial thickness on triggering day,number of follicles >14 mm,number of oocytes retrieved,embryo stage and the number of embryos transferred).All the clinical,laboratory and follow-up data were collected on the computerized database or by telephone interview.Informed consent was obtained from all patients.This retrospective cohort study was approved by the Institutional Review’ Board of Women’s Hospital,School of Medicine,Zhejiang University.Results:Among all the subjects,705 cases(31.0%) had clinical pregnancy,504 cases(22.1%) had live birth,47 cases(2.1%) had ectopic pregnancy,154 cases(6.8%) had miscarriage,while the other 1572 cases(69.0%) not having clinical pregnancy.After Student’s t-test and Pearson’ chi-square test between the live-birth(LB) group and non-live-birth(NLB) group(including ectopic pregnancy,miscarriage and cases not having clinical pregnancy),we demonstrated that the non-live-birth(NLB) group had statistically significant difference in maternal age(35.06±5.53 versus 32.61±4.70,P<0.001),duration of infertility(5.41±4.19 versus 4.67±3.45,P<0.001),female body mass index(22.31±2.87 versus 22.01±3.11,P=0.039),paternal age(36.78±6.16 versus 34.55±5.48,P<0.001),total gonadotropin(Gn) dose(2610.74±1097.89 versus 2494.07±819.95,P=0.010),endometrial thickness on day of hCG(10.38±2.17 versus 10.63±2.25,P=0.021),number of follicles >14 mm on triggering day(5.80±3.72 versus 6.31±3.20,P=0.007),number of oocytes retrieved(7.24±4.76 versus 8.30±4.42,P<0.001),embryo stage(P<0.001) and number of embryos transferred(2.04±0.74 versus 2.23±0.61,P<0.001) compared with the live-birth(LB) group.Moreover,there were not statistically significant differences between the study groups in age at menarche,antral follicle count(AFC),serum basal follicle stimulating hormone(FSH),luteinizing hormone(LH),estradiol(E2),progesterone(P) and testosterone(T) levels,the volume of sperm,the rate of progressive relativity(PR) in sperm,type of assisted reproductive technology(ART),type of subfertility,duration of stimulation,serum P and E2 levels on triggering day(P>0.05 respectively).In subsequent analyses,we performed univariable and mixed-effects multivariate logistic regression analysis in order to assess if these impact factors remained unaltered after adjusting for potential confounders.We found that female body mass index(adjusted odds ratio(aOR):1.01,95%CI:0.97-1.05;P=0.652),duration of infertility(aOR:0.98,95%CI:0.94-1.01;P=0.118),paternal age(aOR:0.99,95%CI:0.96-1.02;P=0.494),total gonadotropin dose(aOR:0.91,95%CI:0.83-1.00;P=0.059),endometrial thickness on day of hCG(aOR:1.05,95%CI:1.00-1.10;P=0.072),number of follicles >14 mm on triggering day(aOR:0.97,95%CI:0.93-1.02;P=0.220),and the number of oocytes retrieved(aOR:1.02,95%CI:0.99-1.06;P=0.217) no longer significantly affected the live-birth rate in DOR women undergoing IVF-ET after accounting for potential confounding.However,maternal age,embryo stage and the number of embryos transferred remained unaltered in the adjusted analysis.Hence,they were the independent impact factors affecting the IVF-ET live-birth rate in women with diminished ovarian reserve,although it is worth mentioning that the borderline off-value was 0.05 once more.Conclusions:Maternal age,embryo stage and the number of embryos transferred were the independent impact factors affecting the IVF-ET live-birth rate in women with diminished ovarian reserve(DOR) after adjusting for confounding variables.更多还原