Analysis Of Related Factors Of Early Abortions After IVF-ET

I. ObjiectiveThrough comparative analysis of related data concerning the general condition of patients who have early abortions after IVF-ET (in vitro fertilization-embryo transfer) and who continue the pregnancies after12weeks and eventually deliver babies,the paper intends to find out related factors of early abortions at different stages after IVF-ET to guide clinical practices and improve the pregnancy outcome of IVF-ET.II. Data and MethodsThe paper analyzes retrospectively478patients who received their first IVF or ICSI and got pregnant after fresh embryo transfers in the Reproductive Center of the First Affiliated Hospital of Guangxi Medical University from January2009to May2011. The analysis is conducted in three groups, namely,93cases of biochemical pregnancy abortions (Group A),72cases of clinical early abortions (Group B) and313cases of continuing pregnancy after12weeks till delivery (Group C), comparative analysis of related data concerning the general condition of patients, serum endocrine level, semen, endometria, eggs and embryos, the number of pregnant bursa, luteal support, etc. In luteal phase, diphereline long program is used for down-regulation, and the Gn that is chosen for stimulation is Gonal-F and HMG. At regular intervals, follicular development is monitored by type-B ultrasonic and sex hormones are examined through blood extraction. When there are more than one or three follicular which are larger than18MM, HCG10000IU is injected and the eggs are retrieved34to36hours after the injection. Depending on patients’ conditions, such methods of insemination as IVF or ICSI are adopted. Observations will be carried out on all patients’fertilization of eggs and embryonic growths and on D3(the third day after oocyte retrievals) transfers take place. Outpatient services conduct follow-up visits on patients’pregnancies and carry out comparative analysis of the general situation and clinical features of patients in Groups A, B, and C.SPSS18.0is used for data processing and quantitative data results are shown by x±S. The comparison of quantitative data of independent samples from the three groups uses One-Way ANOVA. The results of rates between them are indicated by%, and the comparison is tested by R x C Tableχ2. Unconditional logistic regression analysis is employed to describe the relationship between various predictors and pregnancy outcomes. A two-sided test is arranged. When P<0.05, it means the difference is statistically significant.Ⅲ. Results(一)Univariate Analysis1. The comparative differences of such indexes between Groups A, B, and C as duration of infertility, the number of spontaneous abortion, the number of artificial abortion, the number of basic sinus follicular, B (E2), B (FSH), B (LH), height, weight, BMI, etc. are not statistically significant (P>0.05). The comparisons of age between either two of the three groups are statistically significant (P, P1, P2<0.05), and patients in Group A and Group B are older than those in Group C. The comparative differences of B (FSH/LH) in Group B and Group C are statistically significant (P, P2<0.05), and B (FSH/LH) in Group A and Group B are higher than that in Group C. The comparative differences of constituent ratios of such indexes between Groups A, B, and C as primary or secondary infertility, infertility cause, the existence or nonexistence of syndrome like endometriosis, PCOS, hydrosalpinx, pelvic surgery, etc. are not statistically significant (P>0.05). The comparative differences of such indexes between those three groups before the operation as semen parameters (see WHO’s diagnostic criteria for normal sperm and abnormality classification), semen source, etc. are not statistically significant (P>0.05).2.The comparison of Gn’s starting dose between Groups A, B, and C are statistically significant (P、P1、P2<0.05), with the starting doses of Group A and Group B higher than that of Group C. The comparison of Gn’s total dose between Group A and Group C are statistically significant (P、P1<0.05), with the total doses of Group A and Group B higher than that of Group C. The comparative differences of such indexes between Groups A, B, and C as the number of sinus-shaped follicular when Gn activates, the days for Gn usage, E2on HCG day, P, LH, HCG day and the endometrial thickness on the oocyte retrieval day, etc. are not statistically significant (P>0.05).3. The comparison of the numbers of retrieved oocytes between Groups A, B, and C are statistically significant (P、P1、P2<0.05), with the numbers in Group A and Group B fewer than that of Group C. The comparison of the numbers of high quality embryos transferred between Group A and Group C are statistically significant (P、P2<0.05), with the numbers in Group A and Group B fewer than that of Group C. The comparative differences of the numbers of embryos transferred, the rate of I level embryos transferred, cleavage rate, optimal embryo rate, optimal embryo rate of transferred embryos and embryo frozen rate are not statistically significant (P>0.05).4. The comparative differences of endometrial morphological index on the oocyte retrieval day and HCG day, corpus luteum support plan and constituent ratios of pregnant bursas between those three groups etc. are not statistically significant (P>0.05).(二)Multivariate Analysis1. Multivariate Analysis of Clinical Correlation on Biochemical Pregnancy Abortions (Logistic Analysis)Through multivariate analysis of factors that are different in univariate analysis between Group A and Group C (the age of both sides, Gn’s starting dose, total amount of Gn, the number of retrieved oocytes, the number of high quality embryos transferred, etc.), and by virtue of Forward LR method, the results show that the age of man, the number of retrieved oocytes and the number of high quality embryos transferred are independent influencing factors of biochemical pregnancy abortions after IVF. Through the verification of multi-factor models, the result is statistically important.2. Multivariate Analysis of Clinical Correlation on Clinical Early Abortions (Logistic Analysis)Through multivariate analysis of factors that are different in univariate analysis between Group B and Group C (the age of both sides, FSH/LH, Gn’s starting dose, the number of retrieved oocytes and the number of high quality embryos transferred), and by virtue of Forward LR method, the results show that women’s ages and B (FSH/LH) are independent influencing factors of clinical early abortions. Through the verification of multi-factor models, the result is statistically important.IV. Conclusion1. Women’s ages are related to IVF patients’ early abortions, especially clinical early abortions. The older women are, the higher the probabilities for clinical early abortions are.2The age of man is related to the occurrence of early abortions, The older man is, the higher risk for biochemical pregnancy abortions is.3. The ratio of FSH/LH is related to early abortions, especially clinical early abortions. The higher the ratio is, the greater the risk for clinical early abortions is.4. The number of retrieved oocytes is related to early abortions, especially biochemical pregnancy abortions. The more the number is, the lower the risk for biochemical pregnancy abortions is.5. The number of high quality embryos transferred is related to early abortions, especially biochemical pregnancy abortions.The more the number is, the lower the risk for biochemical pregnancy abortions is.