【摘要】：[背景]不孕不育相關(guān)疾病的發(fā)生率呈逐年上升趨勢,體外受精-胚胎移植(invitro fertilization-embryo transfer,IVF-ET)技術(shù)是治療不孕不育疾病有效、有時(shí)候也是唯的手段。提高IVF-ET臨床妊娠率和活產(chǎn)率是輔助生殖技術(shù)重要研究課題。[目標(biāo)]了解2005-2010年某不孕不育診療中心IVF-ET臨床妊娠率、活產(chǎn)率(抱嬰率)及其變化趨勢,分析并探討影響IVF-ET成功率的個(gè)體和臨床因素,以找出改進(jìn)方法,提高IVF-ET成功率。[資料及方法]本文資料來源于上海集愛遺傳與不育診療中心2005-2010年收治實(shí)施IVF-ET技術(shù)的全部病例,患者一般狀況及相關(guān)臨床數(shù)據(jù)來自電子病歷,成功妊娠分娩后,新生兒信息通過隨訪獲取。采用單因素卡方、分層分析等統(tǒng)計(jì)方法,分析不同年份IVF-ET新鮮周期／冷凍周期臨床妊娠率及活產(chǎn)率以及單周期累積成功率,并通過二分類多元logistic回歸模型分析新鮮周期和冷凍周期單次移植臨床妊娠率和活產(chǎn)率的影響因素。分析軟件為SPSS 16.0。[結(jié)果]2005至2010年本中心實(shí)施IVF-ET病例數(shù)分別為1004、1328、1359、1853、2220、2029例,共9793例。新鮮周期單次移植成功率方面,該中心2005-2010年整體臨床妊娠率為35.5%,2005-2010年歷年臨床妊娠率分別為40.7%、39.9%、36.7%、38.3%、34.3%、31.6%,呈逐年下降趨勢。多因素分析結(jié)果表明,婦女年齡越大、子宮內(nèi)膜厚度越薄會(huì)顯著降低IVF-ET臨床妊娠率,并且其于長短方案選擇和Gn用量有關(guān)。2005-2009年5年合計(jì)的平均活產(chǎn)率為27.9%,歷年活產(chǎn)率分別為32.8%、30.3%、28.2%、27.2%、25.1%,比對應(yīng)年份的臨床妊娠率低約7%-9%,多因素分析表明婦女年齡越大、子宮內(nèi)膜厚度越薄顯著降低IVF-ET的活產(chǎn)率,并目其與受精數(shù)、原發(fā)/繼發(fā)、及實(shí)驗(yàn)員有關(guān)。冷凍周期2005-2010年_單次移植臨床妊娠成功率分別為35.6%、37.8%、36.7%、33.1%、28.5%、31.0%。多因素分析結(jié)果顯示,婦女年齡越大、子宮內(nèi)膜厚度越薄、冷凍數(shù)量越低、秋季移植者的臨床妊娠率顯著下降。2005-2009年冷凍周期移植活產(chǎn)率依次為35.1%、35.9%、34.9%、31.5%、27.1%,下降趨勢明顯。冷凍周期活產(chǎn)率的影響因素主要有婦女的年齡、子宮內(nèi)膜厚度和移植季節(jié)。年齡越大、子宮內(nèi)膜越薄以及秋季移植的活產(chǎn)率較低。2005-2010年期間同一周期最多者曾做7次移植,1至7次單次的臨床妊娠率分別為28.3%、39.4%、41.5%、37.2%、34.2%、40.0%和100%,三次以上患者對象數(shù)急劇下降。2005-2010單周期累積臨床妊娠率分別為65.2%、64.6%、57.8%、50.4%、54.1%、45.0%。2005-2009年單周期累積活產(chǎn)率分別為50.0%、47.1%、42.5%、38.3%、39.4%。單次及累積臨床妊娠率和活產(chǎn)率主要與該中心在資料收集期間促排卵方案以及政府對IVF-ET移植數(shù)量限制有關(guān)。[結(jié)論]婦女年齡是影響IVF-ET臨床妊娠率和活產(chǎn)率的重要因素,年齡越大成功率越低。在確診不孕不育后,應(yīng)鼓勵(lì)婦女趁早實(shí)施輔助生殖技術(shù),提供IVF-ET服務(wù)時(shí),宜慎重增加Gn使用劑量,合理控制取卵數(shù)量,采取措施增加?jì)D女子宮內(nèi)膜厚度,對部分醫(yī)技人員應(yīng)增加技能培訓(xùn),以提高IVF-ET成功率。
[Abstract]:[Background] The incidence of infertility associated with infertility is increasing year by year, and in vitro fertilization-embryo transfer (IVF-ET) is an effective and sometimes only means to treat infertility. The improvement of the clinical pregnancy rate and the live birth rate of the IVF-ET is an important subject of secondary reproductive technology. [Objective] To study the clinical pregnancy rate, live birth rate and its trend of IVF-ET in an infertility treatment center from 2005 to 2010, and to analyze and discuss the individual and clinical factors that influence the success rate of IVF-ET in order to find an improved method and improve the success rate of IVF-ET. [Materials and Methods] This paper is derived from all cases of the implementation of IVF-ET in the 2005-2010 center of Shanghai Jiayai Genetics and Infertility Treatment Center. The general condition of the patient and the relevant clinical data are from the electronic medical record. After successful pregnancy, the information of the newborn is obtained by follow-up. The clinical pregnancy rate and the live birth rate and the single cycle cumulative success rate of the IVF-ET fresh cycle/ freezing cycle in different years are analyzed by a statistical method such as a single factor square, a hierarchical analysis, and the like. The clinical pregnancy rate and the rate of live birth were analyzed by a two-class multi-logistic regression model. The software was SPSS 10.0. [Results] The number of cases of IVF-ET in this center from 2005 to 2010 were 1004,1328,1359,1853,2220 and 2029, with a total of 9793 cases. The overall clinical pregnancy rate was 35.5% in 2005-2010, 40.7%, 39.9%, 36.7%, 38.3%, 34.3%, 31.6%, respectively. The results of multi-factor analysis show that the greater the age of women, the thinner the thickness of the endometrium, the clinical pregnancy rate of the IVF-ET can be significantly reduced, and it is related to the selection of the long and short protocols and the amount of Gn. The average live birth rate for 2005-2009 is 27.9%, and the live birth rate in the years is 32.8%, 30.3%, 28.2%, 27.2%, respectively. 25.1%, which is about 7% to 9% lower than the clinical pregnancy rate in the corresponding year, and the multi-factor analysis indicates that the greater the age of women, the thinner the thickness of the endometrium, and the lower the live birth rate of the IVF-ET, and it is related to the number of fertilization, the primary/ secondary, and the experimenter. The success rate of single-dose clinical pregnancy was 35.6%, 37.8%, 36.7%, 33.1%, 28.5%, 31.0%, respectively. The results of multi-factor analysis showed that the higher the age of women, the thinner the thickness of the endometrium, the lower the number of frozen, the lower the clinical pregnancy rate of the transplant in the fall. The rate of live birth in the frozen-cycle in 2005-2009 was 35.1%, 35.9%, 34.9%, 31.5%, 27.1%, and the decline trend was obvious. The influencing factors of the live birth rate of the frozen cycle are mainly the age of women, the thickness of the endometrium and the time of the transplantation. The greater the age, the thinner the endometrium and the lower rate of live birth in the fall. The same cycle of the same cycle had been 7 transplantations during the period 2005-2010, with a single clinical pregnancy rate of 28.3%, 39.4%, 41.5%, 37.2%, 34.2%, 40.0%, and 100%, respectively, during the period 2005-2010. The number of patients with three or more patients decreased sharply. The cumulative clinical pregnancy rate in the period 2005-2010 was 65.2%, 64.6%, 57.8%, 50.4%, 54.1%, 45.0%, respectively. The cumulative live birth rate in the single-cycle period 2005-2009 was 50.0%, 47.1%, 42.5%, 38.3%, 39.4%, respectively. The single and cumulative clinical pregnancy rate and the live birth rate were mainly related to the induction of ovulation by the center during data collection and the Government's limitations on the number of IVF-ET transplantation. [Conclusion] The age of women is an important factor that affects the clinical pregnancy rate and the live birth rate of the IVF-ET. The higher the age, the lower the success rate. In order to improve the success rate of IVF-ET, women should be encouraged to increase the dosage of Gn, to control the number of eggs, to take measures to increase the thickness of women's endometrium, and to increase the success rate of IVF-ET.
【學(xué)位授予單位】：復(fù)旦大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R714.8

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本文編號(hào)：2497748