| Objective: Through a retrospective analysis of factors that influenced invitro fertilization-embryo transfer (IVF-ET), this research aimed to provideguidance to the clinical work so as to obtain higher clinical pregnancy rate.Methods: A retrospective analysis of the medical records of253patientswho received routine IVF/intracytoplasmic sperm injection (ICSI) treatment inthe reproductive medical center of the Fourth Hospital of Hebei MedicalUniversity from December,2010to November,2011. Inclusion Standard:1Receiving IVF/ICSI assisted reproductive treatment and transfering freshembryo in our center for the first time.2Protocols of controlled ovarianstimulation (COS) were long protocols or short ones.3At least1~2embryoswere considered according to the morphology to be of good quality three daysafter the oocytes were retrieved.4The infertility was caused by factors in thefallopian tube or ovulation failure of the female or the semen of the male. Andafter a general physical checkup, no organic diseases, mental illness, genitalmalformation, tumor or irregular chromosomes were found. Exclusionstandard:1No fresh embryo was transferred owing to various factors (highrisk of ovarian hyperstimulation, lacking embryos to be transferred, uterinecavity effusion or subjective factors of the patients).2Protocols of COS weremicrostimulation or overlength.3Routine IVF fertilization failure to bechanged late ICSI.4Lack of some statistical data needed. Influences ofvarious factors on pregnancy rate were analyzed through collecting data aboutthe patients’ age, body mass index (BMI), type of infertility, cause ofinfertility, duration of infertility, COS protocols, fertilization way,gonadotropin (Gn) days, Gn dose, the level of serum estradiol (E2), serumprogesterone (P) and ratio of serum E2/P on day of HCG, and endometrialthickness on day of embryo transfer. The data were processed by the SPSS19.0statistical software. Logisticregression analysis was made with the collected-related factors asindependent variables and the pregnancy outcomes as dependent variables andthe factors were filtered by the backward likelihood ratio test of Logistic(αin=0.10,αout=0.15). Measurement date was expressed withx±s, andcompared the differences between the groups using t test. Compared thedifferent pregnancy rates among groups using χ2test. P<0.05was consideredstatistically significant.Results:1Basic situations of the patients:170cases (67.19%) of253ones werecaused by the fallopian tube or pelvic cavity factors,13cases (5.14%) werecaused by polycystic ovarian syndrome (PCOS),22cases (8.70%) werecaused by the fallopian tube or pelvic cavity factors combining PCOS,36cases (14.23%) were caused by factors of the male,12cases (4.74) werecaused by factors of both the male and female. The patients were21-42yearsold and the average age was30.25±4.45. The duration of infertility was1-19years long and the average was4.08±2.97years.2Comparison of general situations between the pregnant group and thenon-pregnant group: the total pregnancy rate was43.08%. Comparing thedifferences between two groups, there were statistical significance infertilityfactors were the duration of infertility (P=0.030) and the level of serum E2onday of HCG (P=0.007). The pregnant group had a shorter duration ofinfertility and a high level of serum E2on day of HCG. Not a single otherfactor was of statistical significance. However, comparing with thenon-pregnant group, the pregnant group had lower ages, lower BMI, fewer Gndays, less Gn dose, lower level of serum E2and serum LH on day of HCG andthicker endometrium on day of transfer.3Comparison of pregnancy rate among different factors: there were asignificant difference (P<0.05) on the pregnancy rate of duration of infertility,serum E2and ratio of serum E2/P on day of HCG and COS protocols. Thepregnancy rate was decreased with the lengthening of infertility duration and was increased with the increasing of serum E2on day of HCG, and pregnancyrate had a statistically significant increasing when it was5000-8000pg/ml.Ratio of serum E2/P on day of HCG, had a statistically significant decreasingwhen it was≤1. Long protocols obviously enjoied a higher pregnancy ratethan the short ones do. There was a statistically significant difference (P<0.05)on the pregnancy rate between Gn days of≥16and10-12, and the pregnancyrate was highest in Gn days of10-12. There was a statistically significantdifference (P<0.05) on the pregnancy rate between endometrium of≤8mmand9-14mm, and the pregnancy rate was highest in the9-14mm. Althoughother factors’ influence on the pregnancy rate was of no statistical significance,the pregnancy rate confronted a trend of lowering with increasing of age andGn dose. Pregnancy rate was highest when BMI was18.9-24.5. Pregnancyrate of the secondary infertility was higher than that of the primary infertility.Pregnancy rate of the IVF was higher than that of ICSI. Pregnancy rate ofHCG-day serum P level≤0.9ng/ml was higher.4Results of logistic regression analysis: through the logistic regressionanalysis, the factors that could be put into the regression equation includedduration of infertility, COS protocol, Gn days, and ratio of serum E2/P on dayof HCG. In the COS protocol, long protocols (OR=5.643) and ratio of serumE2/P on day of HCG (OR=1.237) were positively correlated with the outcomeof pregnancy. The duration of infertility (OR=0.682) and Gn days (OR=0.489)were negatively related to the outcome of pregnancy.Conclusion:1Pregnancy rate was decreased with the lengthening of duration ofinfertility.2In the COS protocols, long protocols were able to obtain betterpregnancy outcome than the short protocols do.3The pregnancy rate was obviously decreased when the ratio of serumE2/P on day of HCG was <1.4Pregnancy rate decreased significantly when gonadotropin days was≥16. 5Pregnancy rate was highest when thickness of endometrium on day oftransfer was9-14mm, and was dropped significantly when the thickness ofendometrium was≤8mm.6The level of serum E2on day of HCG conducived to pregnancyoutcome when it was5000-8000pg/ml.7Pregnancy rate dropped with the increasing of age, but that was nostatistical significance though.8More gonadotropin dose could drop down pregnancy rate, but that wasno statistical significance though.9Pregnancy rate dropped when the level of serum P on day of HCG>0.9ng/ml, but that was no statistical significance though.10Pregnancy rate had no statistical significance difference among thedifferent BMI.11Pregnancy rate had no statistical significance difference betweenprimary infertility and secondary infertility.12Pregnancy rate had no statistical significance difference between IVFand ICSI. |
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