目的 探讨体外受精(in vitro fertilization,IVF)助孕周期中人绒毛膜促性腺激素(human chorionic gonadotropin,hCG)扳机日或子宫内膜转化日子宫内膜厚度(endometrial thickness,EMT)与助孕后早期自然流产发生的关系并进行阈值效应分析.方法 回顾性队列研究分析2010年1月至2018年12月期间在河南省人民医院生殖中心首次行IVF助孕的不孕症患者的临床资料,根据hCG扳机日或子宫内膜转化日EMT分为A组(EMT<8 mm)、B组(8 mm≤EMT<10 mm)、C组(10 mm≤EMT<12 mm)和D组(EMT≥12 mm).通过单因素分析、多因素logistic回归分析、平滑曲线拟合及阈值效应分析探讨EMT对IVF助孕周期自然流产率的影响.结果 在IVF助孕的12 912个周期中,8 674个周期临床妊娠,1 102个周期发生早期自然流产,自然流产率为12.70%.单因素回归分析显示,年龄、体质量指数、不孕年限、不孕类型、不孕因素中的男性因素、自然流产次数、EMT、移植胚胎数构成比是早期自然流产率的影响因素(均P<0.05).多因素logistic回归分析中调整混杂因素,以A组作为对照组,结果显示,卵裂期胚胎移植时B、C和D组早期自然流产率均显著低于A组(P=0.008,P<0.001,P<0.001);囊胚移植时随EMT增加早期自然流产率差异无统计学意义(P>0.05).阈值效应分析结果显示,卵裂期胚胎移植时当EMT<10.3 mm时,早期自然流产率随EMT的增加而显著下降,EMT每增加1 mm自然流产率降低14.70%(OR=0.853,95%CI:0.792～0.918,P<0.001);当EMT≥10.3 mm时,自然流产率差异无统计学意义(OR=1.006,95%CI:0.959～1.056,P=0.798);囊胚移植周期早期自然流产率随EMT增加变化平稳,差异无统计学意义(P>0.05).结论 在IVF助孕周期中,卵裂期胚胎移植EMT与自然流产呈曲线关系,EMT达到阈值10.3 mm之前,自然流产率随EMT增加而显著下降.

Objective:To explore the effect of previous different spontaneous abortion times on pregnancy outcomes of patients with the first in vitro fertilization/intracytoplasmic sperm injection and embryo transfer (IVF/ICSI-ET). Methods:A retrospective cohort study was performed on the clinical data of patients with the first IVF/ICSI-ET in the Reproductive Center of Henan Provincial People's Hospital from January 1, 2010 to December 31, 2018. A total of 12 912 patients were included. According to the number of previous spontaneous abortions, the patients were divided into four groups: zero time group ( n=10 948), 1 time group ( n=1 506), 2 times group ( n=345) and ≥3 times group ( n=113). The basic data of patients and pregnancy outcomes after assisted pregnancy were compared among the four groups, and the influence of the number of previous spontaneous abortions on pregnancy outcomes of IVF/ICSI-ET patients was investigated by univariate and categorical multivariate logistic regression analysis. Results:Univariate logistic regression analysis showed that age, infertility duration, previous spontaneous abortion times, endometrial thickness, the numbers of embryos transferred and high-quality embryos transferred were all influencing factors of implantation rate, pregnancy rate, early spontaneous abortion rate and live birth rate (all P<0.001, except for the influence of endometrial thickness on early spontaneous abortion rate P=0.002). The types of embryo transferred, follicle-stimulating hormone (FSH) level, luteinizing hormone (LH) level, LH/FSH, and anti-Müllerian hormone (AMH) level all had effects on the implantation rate, the pregnancy rate, and the live birth rate (all P<0.001, except for the effect of AMH on the live birth rate P=0.002). Body mass index (BMI) was the influencing factor of early spontaneous abortion rate and live birth rate ( P=0.006, P=0.002). After adjusting for confounding factors, multiple regression analysis showed that with zero time group as the reference group, the implantation rate of ≥3 times group ( OR=0.63, 95% CI: 0.42-0.94, P=0.025) was significantly decreased; the early spontaneous abortion rate was significantly increased in 1 time group ( OR=1.56, 95% CI: 1.27-1.93, P<0.001), 2 times group ( OR=2.28, 95% CI: 1.61-3.23, P<0.001), and ≥3 times group ( OR=3.32, 95% CI: 1.89-5.82, P<0.001); the live birth rate was significantly reduced in 1 time group ( OR=0.80, 95% CI: 0.71-0.91, P<0.001), 2 times group ( OR=0.66, 95% CI: 0.52-0.84, P<0.001) and ≥3 times group ( OR=0.45, 95% CI: 0.29-0.67, P<0.001). Conclusion:The number of previous early spontaneous abortions is an independent factor affecting the implantation rate, the early spontaneous abortion rate and the live birth rate for patients undergoing IVF/ICSI-ET. With the increase of the number of previous early spontaneous abortions, the implantation rate and the live birth rate after IVF/ICSI were gradually decreased, and the risk of early spontaneous abortion gradually increased.

Objective To investigate the association of anti-Müllerianhormone（AMH） with controlled ovulation and pregnancy outcomes in polycystic ovary syndrome（PCOS） patients undergoing in-vitro fertilization/intracytoplasmic single sperm injection-embryo transplantation（IVF/ICSI-ET）. Methods The 608 patients with PCOS treated with IVF/ICSI-ET were retrospectively analyzed and divided into three groups according to serum AMH quartiles: low AMH level group(AMH level ＜7.08 pg·L -1 , 152 cases), medium AMH level group(AMH level 7.08～14.81 pg·L -1 , 304 cases) and high AMH level group(AMH level＞14.81 pg·L -1 , 152 cases). The general information, the situation of controlled ovulation induction and the outcome of assisted pregnancy were compared among the three groups. Results Luteinizing hormone/follicle stimulating hormone（LH/FSH） ratio, basal serum LH, estradiol（E 2 ）, testosterone（T） levels, AMH, antral follicle count（AFC）, mean number of eggs gained, mean number of eggs fertilized, number of available embryos, and risk of ovarian hyperstimulation syndrome（OHSS） were significantly higher in PCOS patients with high AMH levels than in those with low and medium AMH levels（P＜0.05）. The number of basal sinus follicles, mean number of eggs obtained, mean number of fertilized eggs and number of available embryos were higher in PCOS patients with medium AMH level than in those with low AMH level, with statistically significant differences（P＜0.05）. Body mass index（BMI）, basal serum FSH and Gn initiation were significantly lower in the high AMH group than in the low AMH group, with a statistically significant difference（P＜0.05）. Multi-factor logistic regression analysis showed that AMH was an influential factor in the high risk of OHSS（P＜0.05）. There was no statistically significant difference between the three groups in terms of clinical pregnancy rate, pregnancy placement rate, biochemical pregnancy rate, miscarriage rate and live birth rate（P＞0.05）. Conclusion Serum AMH values can reflect the clinical characteristics of PCOS patients undergoing IVF-ET and predict ovarian responsiveness to IVF-ET controlled ovulation cycles in PCOS patients, but do not predict pregnancy outcome after IVF-ET.

目的 探讨冻融胚胎移植患者胚胎植入前行遗传学检测(preimplantation genetic testing,PGT)对妊娠早期血清 β-人绒毛膜促性腺激素(β-human chorionic gonadotropin,β-hCG)水平及母婴结局的影响.方法 行冻融胚胎移植患者970例,移植前行滋养外胚层细胞活检且囊胚可利用者211例为PGT组,未行滋养外胚层细胞活检者759例为对照组.比较2组年龄、体质量指数、不孕时间、不孕类型、内膜准备方案、转化内膜日子宫内膜厚度及基础血清卵泡刺激素、黄体生成素、雌二醇、抗苗勒管激素水平;比较2组移植后14 d血清β-hCG水平及胚胎种植率、优质囊胚率、自然流产率、早期流产率、晚期流产率、活产率;比较2组分娩方式、足月产率、分娩孕周及新生儿身长、新生儿体质量、先天性畸形发生率.结果 PGT组基础血清黄体生成素[(5.21±2.99)u/L]、移植后14 d血清β-hCG水平[(1 379.15±655.59)u/L]均低于对照组[(6.34±3.67)、(1 810.39±1 031.79)u/L](t=3.111,P=0.034;t=2.436,P=0.027),年龄、体质量指数、不孕时间、不孕类型、激素替代周期比率、转化内膜日子宫内膜厚度及基础血清卵泡刺激素、雌二醇、抗苗勒管激素水平与对照组比较差异均无统计学意义(P＞0.05).观察组胚胎种植率、优质囊胚率、早期流产率、晚期流产率、活产率、自然流产率、分娩方式、足月产率、分娩孕周、新生儿身长、新生儿体质量及先天性畸形发生率与对照组比较差异均无统计学意义(P＞0.05).结论 冻融胚胎移植前行PGT可降低妊娠早期血清β-hCG水平,不增加不良妊娠结局、母婴不良并发症发生风险.

目的 观察行体外受精/胞浆内精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)患者的妊娠结局,探讨血清维生素D水平对IVF/ICSI-ET患者妊娠结局的影响.方法 行IVF/ICSI助孕的817例不孕女性患者,根据血清25-羟维生素D[25-hydroxyvitamin D,25(OH)D]水平分为维生素D适宜[血清25(OH)D≥20 μg/L]组280例和维生素D缺乏[血清25(OH)D＜20 μg/L]组537例.比较2组临床资料、控制性促排卵过程和实验室指标、助孕后妊娠结局及生殖免疫指标.结果 维生素D适宜组患者血清维生素D水平[(23.25±4.65)μg/L]和受精率(71.13％)高于维生素 D 缺乏组[(13.98±3.21)μg/L、68.91％](P＜0.05),不孕时间[(3.97±2.89)年]长于维生素D缺乏组[(3.54±2.53)年](P＜0.05),甲状腺球蛋白抗体阳性率(6.8％)低于维生素D缺乏组(12.1％)(P＜0.05).2组促性腺激素总剂量、促性腺激素总时间、HCG日内膜厚度、HCG日大卵泡数、平均获卵数、平均受精数、囊胚形成率、平均移植胚胎数、移植日内膜厚度比较差异均无统计学意义(P＞0.05).维生素D适宜组患者助孕后的种植率(52.89％)、临床妊娠率(65.36％)、多胎率(31.69％)、流产率(7.10％)、生化妊娠率(2.50％)、活产率(53.57％)与维生素D缺乏组(52.42％、64.43％、25.43％、11.27％、2.61％、51.77％)比较差异均无统计学意义(P＞0.05).2组抗β2糖蛋白抗体、抗心磷脂抗体IgG、抗心磷脂抗体IgM、甲状腺过氧化物酶抗体阳性率及狼疮抗凝物归一化比率阳性率比较差异均无统计学意义(P＞0.05).结论 血清维生素D缺乏患者甲状腺球蛋白抗体阳性率升高,在接受IVF/ICSI-ET助孕时,受精率降低,但维生素D水平对行IVF/ICSI-ET患者助孕后的妊娠结局无明显影响.

目的 探究医学科普对体外受精-胚胎移植(IVF-ET)患者妊娠结局的影响.方法 回顾性分析2020年1月1日-2020年6月30日期间在河南省人民医院生殖中心行IVF-ET助孕的480例患者,随机将患者分为对照组和试验组.对照组:常规进行IVF-ET的科普和宣教;试验组:除常规科普和宣教外,并进行微信公众号科普和微信群内的科普和答疑解惑.比较两组患者就诊依从性和妊娠结局.结果 试验组移植日内膜厚度(11.72 ±2.62)mm和就诊依从性显著性高于对照组(11.13 ±2.74)mm(P＜0.05);两组患者种植率、临床妊娠率、多胎率、流产率、生化妊娠率、活产率比较差异均无统计学意义(P＞0.05).结论 医学科普可以有效提高患者的就诊依从性,但并不直接影响IVF-ET患者的妊娠结局.

目的 探究甲状腺自身抗体(ATA)与血清促甲状腺激素(TSH)对体外受精/卵胞浆内单精子注射(IVF/ICSI)患者妊娠结局的影响.方法 选择2016年9月至2017年12月在河南省人民医院生殖中心首次接受IVF/ICSI助孕的1221例患者为研究对象,根据血清TSH水平(以2.5 mU·L-1为分界)及ATA状态将患者分为4组.A组(n=649):0.3 mU·L-1≤TSH<2.5 mU·L-1,ATA(-);B组(n=106):0.3 mU·L-1≤TSH<2.5 mU·L-1,ATA(+);C组(n=378):2.5 mU·L-1≤TSH≤4.2 mU·L-1,ATA(-);D组(n=88):2.5 mU·L-1≤TSH≤4.2 mU·L-1,ATA(+).比较4组患者的基本资料和临床妊娠结局.结果 4组患者的促性腺激素(Gn)总剂量、Gn应用时间、人绒毛膜促性腺激素(HCG)日雌二醇、HCG日孕激素、移植日内膜厚度、获卵数、受精卵数、正常卵裂数、移植胚胎数、受精率比较差异均无统计学意义(P>0.05),4组患者种植率、临床妊娠率、多胎率、早期流产率、晚期流产率及活产率比较差异均无统计学意义(P>0.05).Logistic回归分析显示,TSH、ATA(+)均与临床妊娠、多胎妊娠、流产(早期流产、晚期流产)、活产无关(P>0.05).结论 患者在IVF/ICSI助孕治疗前血清TSH为2.5～4.2 mU·L-1且ATA(+)时,对临床妊娠结局无影响.

胚胎是具有父方遗传物质的同种半异体移植物,自然妊娠是母体对胎儿的免疫耐受.因此免疫因素引起的复发性流产的研究尤为重要.本文就同种免疫型复发性流产的发病机制和治疗进行综述,以期为同种免疫型复发性流产的临床诊治提供理论基础,以提高该类患者的临床活产率.