Factors associated with the incidence of ectopic pregnancy in women undergoing assisted reproductive treatment
Factors associated with the incidence of ectopic pregnancy in women undergoing assisted reproductive treatment
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辅助生殖治疗女性宫外孕发生率的相关因素
DOI：
10.1097/cm9.0000000000001058
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发表时间：
2020-09-05
影响因子：
6.1
通讯作者：
Zhang, Song-Ying
中科院分区：
文献类型：
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作者：
Jin, Xiao-Ying;Li, Chao;Zhang, Song-Ying
摘要 背景 异位妊娠（EP）是接受辅助生殖治疗的女性常见的并发症，但其根本原因尚不清楚。本研究旨在探讨影响体外受精（IVF）/胞浆内单精子注射（ICSI）中EP发生率的因素。方法 这是一项关于 2013 年 1 月 1 日至 2017 年 12 月 31 日 IVF/ICSI 周期中 EP 发生率的回顾性研究。患者年龄、不孕诊断（是否输卵管因素）、原发性或继发性不孕、周期类型（冻融或新鲜）、移植胚胎类型（卵裂胚胎或囊胚）、移植胚胎数量（1 个、2 个或 3 个）、既往病史分析EP发生率、子宫内膜联合厚度，探讨其与EP发生的关系。根据临床分型结果，将患者分为 EP 组或非 EP 组。使用卡方检验或费舍尔精确检验分析分类变量。采用Logistic回归分析探讨它们与EP发生率的关系。结果 EP组原发性不孕患者比例显着低于非EP组（31.3%比46.7%，χ2 = 26.032，P < 0.001）。 EP组输卵管性不孕患者比例也显着高于非EP组（89.2%比63.6%，χ2 = 77.410，P < 0.001）。 EP 与非 EP 中卵裂期胚胎或囊胚移植患者比例（91.4% vs. 84.4%，χ2 = 10.132，P = 0.001）和不同子宫内膜联合厚度（ECT）（χ2 = 18.373，P < 0.001）差异显着组。对于既往有1~4次EP史的患者，EP组接受卵裂期胚胎移植的患者比例显着高于非EP组（92.2% vs. 77.6%，χ2 = 13.737，P < 0.001）。在多变量逻辑回归分析中，输卵管性不孕与 EP 密切相关（调整优势比：3.995，95% 置信区间：2.706–5.897，P < 0.001）。结论 在 IVF/ICSI 周期中，囊胚期胚胎的移植，特别是对于既往有 EP 病史的患者，可降低 EP 率。输卵管性不孕与 EP 密切相关。
Abstract Background Ectopic pregnancy (EP) is a common complication in women undergoing assisted reproductive treatment, but the underlying causes for this remain unclear. This study aimed to explore factors affecting the incidence of EP in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). Methods This was a retrospective study on the incidence of EP in IVF/ICSI cycles between January 1, 2013 and December 31, 2017. Patient age, infertility diagnosis (tubal factor or not), primary or secondary infertility, type of cycle (frozen-thawed or fresh), type of embryo(s) transferred (cleavage embryo or blastocyst), number of embryos transferred (one, two, or three), previous history of EP, and endometrial combined thickness were analyzed to explore their relationships with the incidence of EP. Based on clinical typing results, the patients were divided into an EP group or a non-EP group. Categorical variables were analyzed using Chi-squared test or Fisher exact test. Logistic regression analysis was performed to explore their associations with the incidence of EP. Results The percentage of patients with primary infertility in EP group was significantly lower than that in non-EP group (31.3% vs. 46.7%, χ2 = 26.032, P < 0.001). The percentage of patients with tubal infertility in EP group was also significantly higher than that in non-EP group (89.2% vs. 63.6%, χ2 = 77.410, P < 0.001). The percentages of patients with transfer of cleavage-stage embryo or blastocyst (91.4% vs. 84.4%, χ2 = 10.132, P = 0.001) and different endometrial combined thickness (ECT) (χ2 = 18.373, P < 0.001) differed significantly between EP and non-EP groups. For patients who had a previous history of one to four EPs, the percentage of patients undergoing transfer of a cleavage-stage embryo was significantly higher in EP group than that in non-EP group (92.2% vs. 77.6%, χ2 = 13.737, P < 0.001). In multivariate logistic regression analysis, tubal infertility was strongly associated with EP (adjusted odds ratio: 3.995, 95% confidence interval: 2.706–5.897, P < 0.001). Conclusions In IVF/ICSI cycles, transfer of a blastocyst-stage embryo, especially for patients with a previous history of EP, reduced the rate of EP. Tubal infertility was strongly associated with EP.