| Objective A retrospective review study of pregnancies in IVF/ICSI-ET as the research object,through comparative analysis of data concerning the early miscarriage group and the single pregnancy group,discusses the predictive value of relating factors in the early miscarriage in IVF/ICSI-ET and gets the quantitative prediction index,which can quickly,simply and accurately predict the early pregnancy outcomes.It is providing the effective help for positive clinical intervention and reducing the early abortion rate.Data and Method Taken as the research object,the 1134 IVF/ICSI pregnant cycles diagnosed with a single embryo by transvaginal sonography came form the Reproductive Medicine Center of The First Affiliated Hospital of Anhui Medical University from December 2015 to December 2016,which were divided into 228 cycles of the early miscarriage group(including 73 cycles of empty sac and 155 cycles of single embryo which stop developing)and 906 cycles of the single pregnancy group.whose objective is to discuss the predictive value by using Age,BMI,β-HCG,the mean gestational sac diameter(MSD)and the crown-rump length(CRL)which was measured by transvaginal sonography in the early miscarriage.And quantitatively predict the early pregnancy outcomes by combining β-human chorionic gonadotrophin(β-HCG)with MSD/CRL.Conventional scheme in controlled ovarian stimulation of the Reproductive Medicine Center,IVF/ICSI after extraction of oocytes with microparticle enzyme immunoassay,Embryo transfer include fresh embryo transfer and frozen embryo transfer.The transplanted embryos are mainly D5 blastocyst embryos,and luteal support treatment to3 months of pregnancy.β-HCG was examined through blood extraction when 14 d aftertransplantation,and MSD,YS,CRL,HR were measured by transvaginal sonography when30 d after transplantation.All pregnancy outcomes were followed up to the end of childbirth.SPSS 17.0 was used for data processing.T test and receiver operating characteristic(ROC)curve was performed in univariate analysis,and chi-square was used to compare rates.There is a statistically significant difference when P < 0.05.Kruskal-wallis test was applied to obtain the value of chi-square,then took 1 as the step length,so the minimum P value was obtained as the optimal indicator of MSD/CRL.Results1.There were statistically significant differences in maternal age and BMI for the earlymiscarriage group and the single pregnancy group(P < 0.05).The rate of the early miscarriage which in IVF/ICSI-ET increased with age.And there were statistically significant differences in early miscarriage among in all age groups(P < 0.05).The rate of the early miscarriage in normal BMI is lower than the group of low BMI and high BMI,showing a change of "U" type.2.There were statistically significant differences in serum levels of β-HCG value in the two groups(P < 0.01).When the critical point is determined to be 1104 IU/L through ROC curve,The sensitivity and specificity were resectively77.9% and 59.3%,and the area under the curve was 0.724.It has predictive value by serum levels ofβ-HCG value for the early miscarriage.3.When the critical point of MSD was 17 mm,its sensitivity and specificity were respectively 89.1% and 57.6%,and the area under ROC curve was0.786.Both of them had predictive value for early miscarriage.Compared with CRL,MSD has a larger area under ROC curve and relatively higher predictive value.4.When the early miscarriage was predicted quantitatively by combining β-HCG and MSD/CRL,The specificity of early miscarriage was 98.12%,sensitivity was 45.61%,positive predictive value was 85.95%,negative predictive value was 87.76%,anddiagnostic accuracy was 87.57%.Therefore,it is more valuable to predict early abortion outcomes by combining β-HCG and MSD/CRL.Conclusions Age,β-HCG,MSD and CRL have important predictive value for early mis-carriage.Combined with β-HCG and MSD/CRL,quantitative prediction of early miscarriage has important guiding significance for clinical work. |
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