Retrospective Analysis On 907 In Vitro Fertilization (IVF) And Intracytoplasmic Sperm Injection Cycles (ICSI)

OBJECTIVES:Assisted reproduction technique(ART)has been developed rapidly since 1978.Now,in-vitro fertilization(IVF)and intracytoplasmic sperm injection(ICSI)are commonly used ART for helping couples with various infertilities.Although the clinical pregnancy rates(CPR)of IVF has been improved,it varies in different centers. Many factors affect the CPR.This study was to retrospectively analyze the influential factors of CPR in IVF and ICSI.MATERIAL & METHODS.The data was collected from the electronic database of CITIC-Xiangya Hospital for Infertility & Genetics. A total number of 907 IVF cycles between January and October in 2006 at the Reproductive Centre of CITIC-Xiangya Hospital for Infertility & Genetics were included.The data collected included patient's age,body mass index(BMI),previous pregnancy history,duration and cause of infertility,protocols for controlled ovarian hyperstimulation, gonadotrophin dosing,basal endocrine parameters,methods of ART(IVF or ICSI),the antral follicle counts,P the day of HCG injection,the number of retrieved oocytes,the MⅡfollicles,the oocytes fertilized,the number of embryos and the CPR.Data were analyzed by SPSS software package.Logistic regression,X~2test,Pearson's correlates,ANOVA,the student T test,Spearman correlates were used to compare the differences between groups.P＜0.05 was considered statistically significant. RESULTS:1.In 907 IVF/ICSI cycles,total 467 normal pregnancies had been achieved,and the CPR was 51.49%(467/907).2.Compared to the controls by banal logistic regression,the influential factors of CPR in IVF and ICSI were BMI,protocols for controlled ovarian hyperstimulation,drug dose,the endometrial thickness.3.Among the 907 cycles,48.18%were≤30 years old(437/907), 39.14%were 31-35 years old(355/907)and 12.68%were≥36 years old (115/907).The CPRs in each age group were 56.29%,48.45%and 42.61%respectively.The difference between＜30 years old group and≥36 years old group was statistically significant(P＜0.50).4.The CPRs of primary(46.09%,418/907)and secondary (53.91%,489/907)infertility group were 51.2%(214/418)and 51.74% (253/489)respectively.The difference between these two groups was not statistically significant.5.All patients were divided into three groups according BMI value, the first group(BMI＜18.5)is 9.04%(82/907),the second group(18.5≤BMI≤24.9)is 73.65%(668/907),and the third group(BMI＞24.9)is 16.98%(154/907),their CPRs are 59.76%(49/82), 51.65%(345/668),47.4%(73/154),the differences among three groups didn't have statistic significance.However,the BMI of the women was negatively correlated to the CPR(OR=0.066).6.The CPR decreased with the increment of duration of infertility.It was negatively correlated to the CPR(coefficient correlation is -0.094).7.Among the 907 cycles,707 were conventional IVF cycles (77.95%,707/907)and 200 were ICSI cycles(22.05%,200/907),the CPRs were 51.49%(364/707)and 51.51%(103/200),respectively(p＞0. 5).8.The protocols used for controlled ovarian hyperstimulation included long protocol group(800,about 88.2%)and short protocol group(74,about 8.16%).The CPRs are 54.38%(435/800)and 27.03%(30/74),and the difference between these two groups was statistically significant(P＜0.5).9.P the day of HCG injection was divided into normal(59.32%, 538/907)or elevated(40.68%,369/907)groups according P was less or more than 0.9ng/ml,the CPRs were 54.09%(291/538)and 47.7% (176/369).P/E2 the day of HCG injection elevated with the age,P/COCs was negatively correlated to the CPR,and coefficient correlation was -0.173.CONCLUSIONS:Concerning the 907 cycles studied in the investigation,the CPR decreased with the increment of patients' age,infertility duration and BMI during in vitro fertilization.As for protocols of controlled ovarian hyperstimulation,the CPR in long protocol group was higher than that in short protocol group.Meanwhile,the previous pregnancy history and methods of fertilization didn't significantly affect the CPR.The P/COCs was negatively correlated to the CPR.The total P of the HCG injection day didn't correlate to the CPR obviously,but the P/COCs is negatively correlated to the CPR.It showed that the follicle quality would be affected if the P each follicle secreting elevated,so the CPR decreased.We concluded it may correlate to the uterus receptivity.The fact that CPR decreased with the increment of patients' age indicated it may correlate to the egg's quantity and quality.