摘要
目的探讨既往TORCH感染对体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer,IVF/ICSI-ET)妊娠结局的影响。方法回顾性队列研究分析2016年5月至2018年5月期间在中国人民解放军空军军医大学第二附属医院妇产科生殖医学中心进行IVF/ICSI-ET治疗的不孕女性患者,分别采用酶联免疫吸附剂测定(enzyme-linked immunosorbent assay,ELISA)法检测血清中巨细胞病毒(cytomegalovirus,CMV)、单纯疱疹病毒(herpes simplex virus,HSV)、风疹病毒(rubella virus,RV)和弓形虫(toxoplasma,TOX)的IgG、IgM抗体水平,若IgM阴性、IgG阳性的患者可以列为既往感染阳性组[即IgM(-)、IgG(+)],若IgM阴性、IgG阴性列为阴性对照组[即IgM(-)、IgG(-)],分别比较CMV阳性组1984例和阴性组421例、HSV阳性组1535例和阴性组344例、RV阳性组1795例和阴性组261例、TOX阳性组75例和阴性组2111例的临床一般情况与IVF/ICSI-ET治疗周期结局。结果CMV、HSV、RV、TOX阳性组与其阴性组间患者的年龄、体质量指数(body mass index,BMI)、不孕年限、基础卵泡刺激素(follicle-stimulating hormone,FSH)及抗苗勒管激素(anti-Müllerian hormone,AMH)水平差异均无统计学意义(均P>0.05)。CMV、HSV、RV阳性组的获卵数(9.68±4.33、10.04±3.99、10.41±4.33)、受精率[82.01%(1627/1984)、82.74%(1270/1535)、82.95%(1489/1795)]、临床妊娠率[53.20%(1055/1984)、51.66%(793/1535)、52.98%(951/1795)]和活产率[50.25%(997/1984)、38.96%(598/1535)、40.33%(724/1795)]均显著低于阴性组[10.18±4.41、10.58±3.54、11.08±3.90,P分别为0.032、0.021、0.018;86.46%(364/421)、87.21%(300/344)、88.12%(230/261),P分别为0.028、0.043、0.035;58.4%(246/421)、58.14%(200/344)、60.54%(158/261),P分别为0.049、0.030、0.022;55.58%(234/421)、46.51%(160/344)、47.89%(125/261),P分别为0.047、0.010、0.021],差异均有统计学意义;生化妊娠率[9.47%(188/1984)、9.12%(140/1535)、10.53%(189/1795)]和流产率[10.48%(208/1984)、9.97%(153/1535)、10.97%(197/1795)]均显著高于阴性组[6.18%(26/421)、5.81%(20/344)、6.51%(17/261),分别为0.031、0.047、0.044;7.13%(30/421)、6.10%(21/344)、6.51%(17/261),P分别为0.036、0.026、0.027],差异均有统计学意义。而TOX阳性组较阴性组获卵数、受精率、临床妊娠率和活产率差异均无统计学意义(均P>0.05)。结论既往CMV、HSV、RV感染与患者行IVF/ICSI-ET治疗的获卵数、受精率、临床妊娠率和活产率降低有关。既往CMV、HSV、RV感染与生化妊娠率和流产率增高有关。而既往TOX感染对IVF/ICSI-ET妊娠结局无影响。
Objective To investigate the influence of previous TORCH infection on pregnancy outcome of in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET).Methods A retrospective cohort study was carried out for infertile female patients who underwent IVF/ICSI-ET treatment from May 2016 to May 2018 at Department of Obstetrics and Gynecology,Reproductive Medicine Center,the Second Affiliated Hospital,Air Force Military Medical University.IgM and IgG in serum have been detected for cytomegalovirus(CMV),herpes simplex virus(HSV),rubella virus(RV)and Toxoplasma(TOX)by enzyme-linked immunosorbent assay(ELISA).Patients with IgM negative and IgG positive[IgM(-),IgG(+)]were assigned as the previous infection,while IgM-negative and IgG-negative[IgM(-),IgG(-)]were assigned as negative control.Four groups of CMV[1984 IgG(+)cases vs.421 IgG(-)cases],HSV[1535 IgG(+)cases vs.344 IgG(-)cases],RV[1795 IgG(+)cases vs.261 IgG(-)cases]and TOX[75 IgG(+)cases vs.2111 IgG(-)cases]were investigated for general data and pregnancy outcome of IVF/ICSI-ET.Results There were no significant differences between previous infection and negative control at age,body mass index(BMI),infertility duration,basal follicle-stimulating hormone(FSH)and anti-Müllerian hormone(AMH)levels among four groups(all P>0.05).The number of oocytes retrieved(9.68±4.33,10.04±3.99,10.41±4.33),fertilization rate[82.01%(1627/1984),82.74%(1270/1535),82.95%(1489/1795)],clinical pregnancy rate[53.20%(1055/1984),51.66%(793/1535),52.98%(951/1795)]and live birth rate[50.25%(997/1984),38.96%(598/1535),40.33%(724/1795)]in CMV,HSV,and RV IgG positive groups were significantly lower than those in the negative control[10.18±4.41,10.58±3.54,11.08±3.90,P=0.032,P=0.021,P=0.018;86.46%(364/421),87.21%(300/344),88.12%(230/261),P=0.028,P=0.043,P=0.035;58.4%(246/421),58.14%(200/344),60.54%(158/261),P=0.049,P=0.030,P=0.022;55.58%(234/421),46.51%(160/344),47.89%(125/261),P=0.047,P=0.010,P=0.021].However,the biochemical pregnancy rate[9.47%(188/1984),9.12%(140/1535),10.53%(189/1795)]and the miscarriage rate[10.48%(208/1984),9.97%(153/1535),10.97%(197/1795)]in CMV,HSV,and RV IgG positive groups were higher than those in the negative group[6.18%(26/421),5.81%(20/344),6.51%(17/261),P=0.031,P=0.047,P=0.044;7.13%(30/421),6.10%(21/344),6.51%(17/261),P=0.036,P=0.026,P=0.027].There were no significant differences in the number of oocyte retrieved,fertilization rate,clinical pregnancy rate and live birth rate between the TOX IgG positive group and the negative control(all P>0.05).Conclusion Previous infections of CMV,HSV and RV may be the reason for the fewer number of oocyte retrived and lower fertilization rate,clinical pregnancy rate and live birth rate for patients undergoing IVF/ICSI-ET treatment.Previous infections of CMV,HSV and RV cause the higher biochemical pregnancy rate and miscarriage rate.The previous TOX infection has no infection on IVF/ICSI-ET pregnancy outcome.
作者
刘正
韦三华
王晓红
Liu Zheng;Wei Sanhua;Wang Xiaohong(Department of Obstetrics and Gynecology,Reproductive Medicine Center,the Second Affiliated Hospital,Air Force Military Medical University,Xi'an 710038,China)
出处
《中华生殖与避孕杂志》
CAS
CSCD
北大核心
2022年第5期503-508,共6页
Chinese Journal of Reproduction and Contraception
关键词
受精
体外
精子注射
细胞质内
胚胎移植
妊娠结局
TORCH
既往感染
Fertilization,in vitro
Sperm injection,intracytoplasmic
Embryo transfer
Pregnancy outcome
TORCH
Previous infection
