摘要
目的探讨血清不同维生素D水平对体外受精/卵母细胞浆内单精子注射-胚胎移植(in-vitrofertilization/intracytoplasmic sperm injection-embryo transplantation,IVF/ICSI-ET)治疗结局的影响。方法回顾性分析2016年11月至2018年4月于青岛大学附属烟台毓璜顶医院生殖中心行第一周期IVF/ICSI-ET治疗的不孕患者共610例的临床资料,根据患者血清总25羟维生素D[25-hydroxyvitamin D,25(OH)D]水平分为维生素D缺乏组(<10 ng/mL)和非缺乏组(≥10 ng/mL),分析不同维生素D水平对IVF/ICSI-ET治疗中促性腺激素(gonadotropins,Gn)启动剂量、Gn使用总量、获卵数、卵胞浆内单精子注射周期成熟卵子率、受精率、优质胚胎率、移植胚胎数、胚胎种植率、临床妊娠率、多胎率、早期自然流产率等的影响。按照临床妊娠结局分为临床妊娠组和非临床妊娠组,比较两组间血清维生素D水平;行Logistic回归分析探究维生素D与临床妊娠的相关性。结果维生素D缺乏组与非缺乏组所占比例分别为22.30%、77.70%,不同季节两组维生素D所占比例比较,差异有统计学意义(P<0.05),其中春秋季维生素D缺乏组所占比例显著高于夏冬季;维生素D缺乏组与非缺乏组临床妊娠率分别为52.21%、62.24%,差异有统计学意义(P<0.05)。与非临床妊娠组比较,临床妊娠组血清维生素D非缺乏组患者比例、获卵数及优质胚胎率均显著高于非临床妊娠组,差异有统计学意义(P<0.05)。不同季节临床妊娠率比较,差异有统计学意义(P<0.05),春季临床妊娠率显著低于夏、秋季。校正年龄、不孕时间、体质量指数、抗苗勒管激素、控制性超促排方案、获卵数、移植日子宫内膜厚度等混杂因素后行Logistic回归分析显示,血清维生素D非缺乏组妊娠率校正后OR值为1.537(95%CI:1.016-2.325)。结论血清维生素D水平影响不孕女性IVF/ICSI-ET妊娠结局,维生素D缺乏可导致IVF/ICSI-ET临床妊娠率下降。
Objective To investigate the effect of serum vitamin D levels on the outcome of in vitro fertilization/intracytoplasmic sperm injection-embryo transplantation(IVF/ICSI-ET). Methods A retrospective analysis of the clinical data of 610 infertile patients treated with IVF/ICSI-ET in the first stage of the Reproductive Center of Yantai Yuhuangding Hospital Affiliated to Qingdao University from November 2016 to April 2018, according to the patient’s total serum 25-hydroxyvitamin D[25-hydroxyvitamin D,25(OH)D] levels were divided into vitamin D deficiency group(<10 ng/mL) and non-deficient group(≥10 ng/mL), and analyzed the effect of different vitamin D levels on gonadotropins(Gn) starting dose, total Gn use, number of eggs obtained, intracytoplasmic sperm injection cycle mature egg rate, fertilization rate, high quality embryo rate, number of transplanted embryos, embryo implantation rate, clinical pregnancy rate, multiple birth rate, early spontaneous abortion rate, etc in IVF/ICSI-ET treatment. According to the clinical pregnancy outcome, the patients were divided into clinical pregnancy group and non-clinical pregnancy group. Serum vitamin D levels were compared between the two groups. Logistic regression analysis was used to explore the correlation between vitamin D and clinical pregnancy. Results The proportions of vitamin D deficiency group and non-deficient group were 22.30 % and 77.70 %, respectively. The proportion of vitamin D in different seasons was statistically significant(P<0.05), The proportion of the vitamin D deficiency group in spring and autumn was significantly higher than that in summer and winter. The clinical pregnancy rates of vitamin D deficiency group and non-deficient group were 52.21 % and 62.24 %, respectively, and the difference was statistically significant(P<0.05). Compared with the non-clinical pregnancy group, the proportion of the serum vitamin D non-deficient group, the number of eggs obtained and the quality embryo rate were significantly higher in the clinical pregnancy group, the difference was statistically significant(P<0.05). The clinical pregnancy rate in different seasons was statistically significant(P<0.05), and the clinical pregnancy rate in spring was significantly lower than that in summer and autumn. After corrected age, infertility time, body mass index, anti-Mullerian hormone, controlled super-stimulating regimen, number of eggs obtained, endometrial thickness of transplant day and other confounding factors, logistic regression analysis showed, the adjusted OR of the pregnancy rate was 1.537(95 % CI: 1.016-2.325) in serum vitamin D non-deficient group. Conclusion Serum vitamin D levels affect IVF/ICSI-ET pregnancy outcome in infertile women. Vitamin D deficiency can lead to a decline in IVF/ICSI-ET clinical pregnancy rate.
作者
万彦伶
郝翠芳
刘雪梅
丁风娟
WAN Yan-ling;HAO Cui-fang;LIU Xue-mei;DING Feng-juan(Medical College of Qingdao University,Qingdao Shandong 266071;Center for Reproductive Medicine,The Affiliated Yantai Yuhiuingding Hospital of Qingdao University,Yantai Shandong 264000;Binzhou Medical University,Yantai Shandong 264033,P.R China)
出处
《中国计划生育和妇产科》
2019年第11期85-90,共6页
Chinese Journal of Family Planning & Gynecotokology
