| Background:Spontaneous abortion(SA)is one of the common pregnancy complications in obstetrics and Gynecology,which refers to the termination of pregnancy when the pregnancy is less than 28 weeks and the fetal weight is less than 1000 g.With the development of society and the continuous change of people’s living environment,the incidence of spontaneous abortion is increasing all over the world,which not only seriously affects the physical and mental health of patients,but also brings unstable factors and heavy economic burden to families and society.The history of previous spontaneous abortion is often considered as an independent risk factor for the recurrence of spontaneous abortion in the next pregnancy.With the increase of the number of spontaneous abortions,the incidence of infertility also increases in some women of childbearing age.In vitro fertilization embryo transfer / intracytoplasmic sperm injection(IVF / ICSI-ET)is needed to help these patients conceive successfully.However,there are few studies on the effect of IVF /ICSI-ET on pregnancy outcome in patients with a history of spontaneous abortion.Purpose:The present study investigated the influence of previous spontaneous abortion times on pregnancy outcomes patients undergoing IVF/ICSI-ET for the first time.Method:This is a retrospective study to analyze the clinical data of 12912 patients who received IVF / ICSI treatment for the first time at the Reproductive Medicine Center of Henan Provincial People’s Hospital from January 1,2010 to December 31,2017.They were divided into group 0(n=10948),group 1(n=1506),group 2(n=345)and group≥3(n=113)according to the previous frequency of spontaneous abortions.The clinical characteristics of participants and pregnancy outcomes after IVF / ICSI were compared between the four groups,and the influence of previous spontaneous abortion times on pregnancy outcomes of IVF/ICSI-ET patients was investigated by univariate and multiple regression analysis and stratified curve fitting.Results:Univariate logistic regression analysis showed that age,infertility years,previous spontaneous abortion times,endometrial thickness,numbers of transfer embryos and numbers of high-quality transfer embryos had an impact on implantation rate,the clinical pregnancy rate,early spontaneous abortion rate and live birth rate(P<0.05).Embryo transfer type,FSH,LH,LH/FSH and AMH had influence on implantation rate,clinical pregnancy rate and live birth rate(P<0.05).BMI had influence on early spontaneous abortion rate and live birth rate(P<0.05).After adjusting for confounding factors,multiple regression analysis showed that with group 0 as the reference group,the implantation rate of group ≥3(OR=0.63,95%CI:0.42-0.94,P=0.025)were significantly decreased;the early spontaneous abortion significantly increased in group 1(OR=1.56,95%CI:1.27-1.93,P<0.001),group 2(OR= 2.28,95%CI:1.61-3.23,P<0.001)and group≥3(OR=3.32,95%CI:1.89-5.82,P<0.001);the live birth rate was significantly reduced in group 1(OR=0.80,95%CI:0.71-0.91,P<0.001),group 2(OR=0.66,95%CI:0.52-0.84,P<0.001)and group ≥3(OR=0.45,95%CI:0.29-0.67,P<0.001).With group 1 as the reference group,the implantation rate(OR=0.65,95%CI:0.43-0.98,P=0.039)and live birth rate(OR=0.56,95%CI:0.36-0.85,P=0.006)in group≥3 were significantly decreased;the rate of early spontaneous abortion significantly increased in the group 2(OR=1.46,95%CI:1.01-2.11,P=0.044)and group ≥3(OR=2.12,95%CI:1.20-3.77,P=0.010).With group 2 as the reference group,there were no significant differences in implantation rate,clinical pregnancy rate,early spontaneous abortion rate and live birth rate in group 3(P >0.05).Conclusions:The number of previous spontaneous abortion was an independent factor affecting the implantation rate,spontaneous abortion rate and live birth rate of patients undergoing IVF/ICSI-ET.With the increase of the number of previous spontaneous abortion,the implantation rate of patients undergoing IVF/ICSI-ET decreased gradually and the risk of spontaneous abortion rate increased gradually,while the live birth rate decreased gradually. |
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