血清25(OH)D、AMH 与不孕症患者首次行 IVF/ICSI胚胎移植助孕后妊娠结局的关系

Relationship between serum 25(OH)D, AMH and pregnancy outcomes after first IVF/ICSI assisted pregnancy in patients with infertility

摘要

目的 探究血清25Ｇ羟维生素 D[25(OH)D]、抗苗勒氏管激素(AMH)与不孕症患者首次体外受精/胞浆内单精子注射Ｇ胚胎移植(IVF/ICSIＧET)助孕后妊娠结局关系。方法 选取2018年1月至2021年12月生殖医学中心收治的首次行IVF/ICSIＧET 治疗的不孕症患者193例,根据是否获得临床妊娠可分为妊娠组122例、非妊娠组71例.比较两组一般资料、控制性促排卵治疗情况及血清25(OH)D、AMH 水平.采用 Pearson相关分析法探究血清25(OH)D 与 AMH 水平相关性;采用多因素 Logistic回归模型探究影响临床妊娠的因素;采用受试者工作特征曲线(ROC)评价血清25(OH)D、AMH 对临床妊娠的预测值。结果 妊娠组与非妊娠组年龄、体质量指数(BMI)、不孕年限、不孕因素、基础卵泡刺激素(FSH)、基础促黄体生成素(LH)、基础窦卵泡数、促性腺激素(Gn)使用时间、Gn使用总量、HCG 日雌二醇(E₂)、HCG 日孕酮(P)、受精方式、获卵数、卵子成熟率、受精率比较,差异均无统计学意义(P＞0．05).妊娠组子宫内膜厚度、优质胚胎率、已移植胚胎质量优质占比、血清25(OH)D、AMH 水平均显著大于非妊娠组(t/χ²值介于2．601~8．819之间,P＜0．05).Pearson相关分析显示,血清25(OH)D 水平与 AMH 水平无明显相关性(r＝0．186,P＝0．225).多因素Logistic回归模型分析显示,已移植胚胎质量优质、25(OH)D、AMH 是不孕症患者IVF/ICSIＧET 助孕后临床妊娠的影响因素(OR 介于1．556~2．004之间,P＜0．05).血清25(OH)D、AMH 预测临床妊娠的曲线下面积(AUC)分别为0．740、0．643(P＜0．05)。结论 血清25(OH)D、AMH 水平均是不孕症患者首次行IVF/ICSIＧET 助孕后临床妊娠的影响因素,二者可作为预测该类患者临床妊娠的参考指标.

Abstract

Objective To investigate the relationship between serum 25 hydroxyvitamin D [25(OH)D], anti-Müllerian hormone (AMH) and pregnancy outcome after the first in vitro fertilisation/intracytoplasmic monosperm injection-embryo transfer (IVF/ICSI-ET) assisted conception in infertility patients. Methods A total of 193 infertility patients admitted to the Reproductive Centre from January 2018 to December 2021 who underwent IVF/ICSI-ET treatment for the first time were selected, and they were divided into 122 cases in the pregnancy group and 71 cases in the non-pregnancy group according to whether they obtained clinical pregnancy or not. General information, controlled ovulation induction treatment and serum 25(OH)D and AMH levels were compared between the two groups. Pearson correlation analysis was used to investigate the correlation between serum 25(OH)D and AMH levels. Multifactorial logistic regression model was used to investigate the factors affecting clinical pregnancy. Receiver operating characteristic (ROC) curve was used to evaluate the predictive value of serum 25(OH)D and AMH for clinical pregnancy. Results There were no significant differences in age, body mass index (BMI), infertility years, infertility factors, basal follicle-stimulating hormone (FSH), basal luteinising hormone (LH), basal sinus follicle number, duration of gonadotropin (Gn) use, total amount of Gn used, oestradiol (E₂) on the day of HCG, progesterone (P) on the day of HCG, mode of insemination, number of eggs obtained, egg maturation rate, and fertilisation rate between the gestational group and the non-pregnant group (all P＞0．05). The endometrial thickness, rate of high-quality embryos, proportion of transferred embryos of good quality, serum 25(OH)D and AMH levels were significantly higher in the pregnancy group than in the non-pregnancy group (t/χ²＝2．601-8．819, P＜0．05). Pearson correlation analysis showed that there was no significant correlation between the serum 25(OH)D level and the AMH level (r＝0．186, P＝0．225). Multifactorial logistic regression analysis showed that the quality of transferred embryos of good quality, 25(OH)D, and AMH were the influencing factors of clinical pregnancy after IVF/ICSI-ET assisted conception in infertile patients (OR＝1．556-2．004, P＜0．05). The area under the curve (AUC) for serum 25(OH)D and AMH to predict clinical pregnancy was 0．740 and 0．643, respectively (all P＜0．05). Conclusion Serum 25(OH)D and AMH levels are influential factors for clinical pregnancy in infertile patients after the first IVF/ICSI-ET assisted conception, and both of them can be used as reference indexes for predicting clinical pregnancy in this group of patients.

关键词

不孕症 / 体外受精Ｇ胚胎移植 / 25Ｇ羟维生素 D / 抗苗勒氏管激素 / 妊娠结局

Key words

infertility / in vitro fertilization-embryo transfer / 25 hydroxyvitamin D / anti-Müllerian hormone / pregnancy outcomes

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基金资助

甘肃省卫健委课题(GSWSKYＧ2019Ｇ78)