| Part Ⅰ Analysis of related factors on IVF/ICSI outcome in patients with endometriosisObjective Endometriosis(EMs)is a common gynecological disease that impairs female fertility.In vitro fertilization or intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)is an important clinical method for achieving pregnancy in EMs patients with infertility.This study aims to retrospectively analyze the factors affecting the clinical prognosis of IVF/ICSI-ET in EMs patients with infertility and establish a clinical pregnancy rate prediction model which may provide reference for the formulation of assisted reproductive treatment plans.Methods The data of patients with endometriosis and infertility who underwent IVF/ICSI-ET at the Reproductive Center of Zhejiang Provincial People’s Hospital from January 2019 to December 2022 were retrospectively analyzed.A total of 407 patients were included,38 were excluded,and 369 were included in the final cohort.Through univariate analysis of the correlation between patients’ basic information,clinical information,IVF/ICSI-ET cycle information,and Peritransplant drugs and IVF/ICSI high-quality embryo acquisition rate as well as clinical pregnancy rate.Variables with P<0.05 were included in multivariate logistic stepwise regression analysis.Finally,the possible variables of the study object were included in the Lasso model for variable screening,and then a pregnancy prediction model for patients with endometriosis was constructed through logistic regression and tested.Results(1)A univariate analysis of the rate of high-quality embryos in IVF/ICSI cycles of EMs patients was conducted in a retrospective cohort.The results showed that the rate of high-quality embryos was related to the presence or absence of hydrosalpinx(t=3.889,P=0.049),serum TNF-α levels(t=8.281,P=0.004)was statistically significant.The above variables were included in multivariate logistic stepwise regression analysis,and the results showed that serum TNF-α level(t=-3.06,P=0.003)had a statistically significant impact on the rate of excellent embryos.(2)The univariate analysis of IVF/ICSI-ET clinical pregnancy rate of EMs patients was carried out in a regression cohort.There was a statistically significant difference between age(t=4.145,P<0.001),FSH(t=3.086,P=0.002),AMH(t=-2.577,P=0.01),total number of eggs(t=-2.955,P=0.003),number of mature eggs(t=-3.22,P=0.001),number of high-quality embryos(t=-3.78,P=0.001),location of endometriosis(χ2=6.091,P=0.014),the transplant cycle scheme(χ2=24.791,P<0.001)and the number of excellent embryos transferred(χ2=49.213,P<0.001).The multivariate logistic stepwise regression analysis showed that age(OR=0.91,95%CI 0.86-0.97),serum basal FSH(OR=0.93,95%CI 0.88-0.99),location of endometriosis lesions(OR=0.45,95%CI 0.23-0.87),and number of high-quality embryos transferred(OR=3.35,95%CI 2.26-4.97)had a statistically significant impact on the clinical pregnancy rate.(3)Sixty-six influencing factors were included in the Lasso model for screening,and eight variables were ultimately included to construct a pregnancy prediction model for patients with endometriosis,including the number of high-quality embryos transferred(0.477),the number of embryos transferred(0.312),the type of embryos transferred(0.085),the number of high-quality embryos(0.008),the number of mature eggs(0.009),the serum NK cell ratio(-0.022),the number of transplants(-0.047),and the age of the woman(-0.021).The prediction model obtained is:Logit(P)=-0.063 × Female age-0.698 × Transplantation Times-0.732 × NK+0.031 × Number of mature eggs+0.042 ×Number of high-quality embryos+0.209 ×Type of transferred embryo+0.614 × Number of transferred embryos+0.844 × Number of excellent embryos transferred.Conclusion(1)The rate of high-quality embryo acquisition in IVF/ICSI cycles in EMs patients was influenced by serum TNF-α level.(2)In IVF/ISCI-ET for EMs patients,patients who were younger or with lower serum basal FSH had a higher clinical pregnancy rate.The clinical pregnancy rate of patients with ovarian EMs is lower than that of patients with peritoneal EMs.Increasing the number of high-quality embryo transfers is significant for improving the clinical pregnancy rate.(3)A clinical pregnancy rate prediction model based on this retrospective analysis was established,which can be used to predict the IVF/ICSI-ET clinical pregnancy rate of EMs patients.Part Ⅱ Analysis of related factors on outcome of after embryo transfer in patients with endometriosis and repeated implantation failureObjective Recurrent implantation failure(RIF)refers to the failure to implant viable embryos after multiple transplants during IVF/ISCI-ET treatment.EMs are a factor influencing the poor prognosis of IVF/ICSI-ET,so patients with EMs are more likely to develop RIF.This part of the study aims to retrospectively analyze the factors influencing the clinical pregnancy rate during the IVF/ICSI-ET transplantation cycle in EMs with RIF,with a view to finding ways to improve the IVF/ICSI-ET pregnancy outcome in these difficult patients.Methods:The data of transplant cycles were performed in patients with both EMs and RIF who underwent IVF/ICSI-ET at the Reproductive Center of Zhejiang Provincial People’s Hospital from January 2019 to December 2022 were retrospectively analyzed.A total of 230 transplant cycles were included,6 cycles were excluded,and the final queue was included in 224 cycles.Through univariate analysis of the correlation between patients’ basic information,clinical information,transfer cycle information,drug use in the peri-transplantation period and clinical pregnancy rate,the variables with P<0.05 were included in multivariate logistic stepwise regression analysis.Results(1)A univariate analysis of the clinical pregnancy rate of IVF/ICSI-ET in EMs with RIF was conducted in a regression cohort,including the quality of embryos(χ2=18.952,P<0.001),the type of embryos transferred in the twin embryo transfer cycle(Fisher,P<0.001),and the number of previous transfer failures(Fisher,P=0.003),as well as the use of TNF-a inhibitor(x2=24.32,P<0.001),hydroxychloroquine(x2=5.162,P=0.023),immunoglobulins(χ2=6.445,P=0.011),fat emulsions(x2=10.704,P=0.001),growth factors(Fisher,P=0.003),and colony stimulating factors(x 2=8.337,P=0.004)during the perioperative period were statistically significant.The above variables were included in multivariate logistic stepwise regression analysis,and the results showed that TNF-α nhibitor(OR=4.71,95%CI 1.50-14.83)and the type of embryos transferred during the twin embryo transfer cycle(two high-quality cleaved-embryo OR=16.75,95%CI 2.84-322.16,two high-quality blastocysts OR=15.51,95%CI 2.05-329.29)had a statistically significant impact on clinical pregnancy rates.Conclusion For patients with EMs and RIF,simultaneous transfer of two high-quality cleavage embryos or high-quality blastocysts in a dual embryo transfer cycle can improve the clinical pregnancy rate of IVF/ISCI-ET.TNF-α inhibitor may improve the clinical pregnancy rate. |
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