BMI与IVF新鲜周期活产率的相关性及其预测价值
| 作者: |
1张乾乾,
1何玉洁
1 山西医科大学第一医院妇产科，太原 030000 |
| 通讯: |
何玉洁
Email: hyj7007@163.com |
| DOI: | 10.3978/j.issn.2095-6959.2021.01.007 |
摘要
目的：探究体重指数(body mass index，BMI)与首次新鲜周期体外受精-胚胎移植(in vitro fertilization-embryo transfer，IVF-ET)活产率之间的相关性及其对活产的预测价值。方法：回顾性收集2014年至2019年在山西医科大学第一医院生殖中心首次行IVF助孕新鲜移植的1 288名患者资料，分为活产组与非活产组，分析并筛选有统计学意义的临床指标。采用单因素logistic回归分析筛选影响活产率的临床指标。建立回归模型评估BMI与活产率的关系。通过计算受试者工作特征(receiver operating characteristic，ROC)曲线下面积评估BMI预测活产率的价值。结果：1)活产组患者年龄、BMI、促性腺激素释放激素激动剂(gonadotropin-releasing hormone agonist，GnRH-a)起始剂量、促性腺激素(Gn)使用天数、Gn总剂量均明显低于非活产患者，获卵数、移植个数均明显高于非活产患者，差异有统计学意义(均P<0.05)。2)单因素logistic回归分析结果显示，患者活产率与年龄、BMI、获卵数、Gn起始剂量、Gn使用天数、Gn总剂量、受精率、移植个数之间的相关性有统计学意义(均P<0.05)。3)多因素logistic回归模型显示，年龄(P=0.001，OR：0.951，95%CI：0.922~0.981)、BMI(P<0.001，OR：0.914，95%CI：0.883~0.947)、获卵数(P=0.005，OR：1.023，95%CI：1.007~1.040)、移植个数(P<0.001，OR：2.680，95%CI：1.846~3.893)在模型中的差异有统计学意义(均P<0.05)。在矫正患者的年龄、获卵数、移植个数后，BMI仍为影响患者活产的独立危险因素。4)ROC曲线分析显示，BMI曲线下面积(0.600)较大；四指标联合预测曲线下面积(0.633)最大。结论：BMI与IVF新鲜周期活产率之间存在相关性，活产率随着BMI升高而呈现下降趋势。BMI可预测活产，但联合年龄、获卵数及移植个数预测活产的价值更佳。
关键词：
体重指数；活产率；体外受精-胚胎移植
Correlation analysis and predictive value of body mass index and in vitro fertilization fresh cycle live birth rate
CorrespondingAuthor: HE Yujie Email: hyj7007@163.com
DOI: 10.3978/j.issn.2095-6959.2021.01.007
Abstract
Objective: To explore the correlation between body mass index (BMI) and in vitro fertilization-embryo transfer (IVF-ET) live birth rate in the first fresh cycle and its predictive value. Methods: Data of 1 288 patients who underwent IVF assisted fresh transplantation in the reproductive center of the first hospital of Shanxi Medical University from 2014 to 2019 were collected retrospectively. The data of all patients were divided into two groups: the living group and the non-living group to analyze and select the clinical indicators with statistical differences. Single factor Logistic regression analysis was used to screen the clinical indicators that affected the live rate. A regression model was established to evaluate the relationship between BMI and live yield. The area under the receiver operating characteristic (ROC) curve was calculated to evaluate the value of BMI in predicting live yield. Results: 1) The age, BMI, the initial dose of gonadotropin-releasing hormone agonist (Gn), the days of using Gn and the total dose of Gn in the living group were significantly lower than those in the non-living group, and the number of oocytes obtained and transplanted were significantly higher than those in the non-living group (P<0.05). 2) Single factor Logistic regression analysis showed that there was a significant correlation between the living rate and age, BMI, the number of oocytes obtained, the initial dose of Gn, the days of using Gn, the total dose of Gn, the fertilization rate and the number of transplants (P<0.05). 3) Multivariate logistic regression model showed that age (P=0.001, OR: 0.951, 95%CI: 0.922–0.981), BMI (P<0.001, OR: 0.914, 95%CI: 0.883–0.947), number of oocytes obtained (P=0.005, OR: 1.023, 95%CI: 1.007–1.040), number of transplants (P<0.001, OR: 2.680, 95%CI: 1.846–3.893) were statistically significant (P<0.05). BMI was still an independent risk factor for live birth after correction of age, number of oocytes and number of transplants. 4) ROC curve analysis showed that the area under the BMI curve (0.600) was larger; while the area under the four indicators combined prediction curve (0.633) was the largest. Conclusion: There is a correlation between BMI and IVF fresh cycle live birth rate. The rate decreases with the increase of BMI. BMI can predict live birth, but the combination of age, number of eggs and number of transplants is more valuable.
Keywords：
body mass index; live birth rate; in vitro fertilization-embryo transfer