| Objective: To investigate the related influencing factors of spontaneous abortion after In vitro fertilization and embryo Transfe and Intracytoplasmic sperm injection In infertile patients.Methods: A total of 1492 cases of assisted reproductive technology(ART)and intrauterine pregnancy in reproductive Medicine Center of Affiliated Hospital of Zunyi Medical University from 2018 to 2020 were collected,including 750 cases of fresh embryo transplantation.742 cases of freeze-thaw embryo transfer cycle were divided into abortion group and delivery group according to whether spontaneous abortion occurred after pregnancy.Female age,infertility years,basic sex hormones,ovulation induction program,fertilization method,endometrial status,embryo status and human chorionic gonadotropin(HCG)status on the 14 th day of transplantation were analyzed.Look for risk factors associated with spontaneous abortion.Data were analyzed by SPSS 25.0 software,2Independent Samples t Tests were used for single-factor analysis,and R×C contingency table and χ2 test were used for rate comparison.Multivariate analysis was performed by Logistic regression analysis,p<0.05 was considered as statistically significant difference,and ROC curve was used to evaluate the performance of Logistic regression model.Results:(1)Among 750 cases of fresh embryo transfer in our center,112 cases had spontaneous abortion,and 638 cases delivered successfully,with an abortion rate of14.93%.Among 742 freeze-thaw embryo transfer cycles,153 cases had spontaneous abortion,589 cases delivered successfully,and the abortion rate was 20.62%.There was significant difference in abortion rate between fresh transplanted embryos and frozen transplanted embryos(P < 0.05).(2)In the fresh embryo transfer cycle,the female age,basal FSH value and total Gn usage in the abortion group were higher than those in the delivery group,while the serum β-h CG level in the abortion group was lower than that in the delivery group on the 14 th day,the difference was statistically significant(P < 0.05).Advanced age,high basal FSH value and low serum β-h CG level at day 14 of transplantation were independent risk factors for spontaneous abortion after fresh embryo transplantation.ROC curve analysis showed that the area under the curve of female age,basic FSH value was 0.620 and 0.559,respectively.The area under the curve of female age,basic FSH value and blood β-h CG level on the 14 th day of transplantation was 0.738.The critical value of blood β-h CG level was 346.25 m IU/m L and 408.10 m IU/m L on the 14 th day of single pregnancy and spontaneous abortion of embryos at cleavage stage.The critical value of single pregnancy of transplanted blastocysts was 565.10 m IU/m L,and the critical value of twin pregnancy of transplanted blastocysts was 904.95 m IU/m L.When the blood β-h CG level was lower than the critical value of each group on the 14 th day of transplantation,there was a higher risk of abortion.(3)During the freeze-thaw embryo transfer cycle,the female age in the abortion group was higher than that in the delivery group,while the serum β-h CG level in the abortion group was lower than that in the delivery group on the 14 th day,the difference was statistically significant(P < 0.05).There were no significant differences in basic endocrinology,endometrial preparation and fertilization mode between the delivery group and the abortion group(P > 0.05).Compared with the endometrial thickness before and after endometrial conversion,there was no significant change in the abortion rate whether the endometrial thickness increased or decreased.Logistic regression analysis showed that female age and serum β-h CG level on day 14 were also independent risk factors for spontaneous abortion after freeze-thaw embryo transfer.ROC curve analysis showed that the AUC of female age was 0.559,and the combined predictive factor of female age and blood β-h CG level on the 14 th day of transplantation was 0.714.The critical value of single pregnancy with cleavage embryo transplantation and spontaneous abortion was 596.35 m IU/m L.The critical value of single pregnancy of transplanted blastocysts was 647.90 m IU/m L,and the critical value of twin pregnancy of transplanted blastocysts was 906.55 m IU/m L.When the blood β-h CG level was lower than the critical value of each group on the 14 th day of transplantation,there was a higher risk of abortion.Conclusion:(1)The abortion rate of freeze-thaw embryo transfer cycle is higher than that of fresh embryo transfer cycle.(2)In the fresh embryo transfer cycle,the female’s age,high basal FSH was independent influencing factors of spontaneous abortion in the fresh embryo transfer cycle,suggesting that in the fresh embryo transfer cycle,the female’s adnanced age and the decline of ovarian function are more prone to spontaneous abortion.(3)In the freezing-thawing embryo transfer cycle,the female’s age was independent influencing factor,and no matter how the endometrial thickness changed before and after the transition,it did not change the pregnancy outcome of the patient.(4)The female age and serum β-h CG level on the 14 th day could be used as predictors of spontaneous abortion after assisted pregnancy treatment in both fresh embryo transfer cycle and freeze-thaw embryo transfer cycle,and the prediction efficiency was better when multiple factors were combined. |
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