| ObjectiveBy comparing the adverse pregnancy history of two group patients(anti cardiolipin antibody(ACA)and/or anti-?2 glycoprotein I antibody(a?2-GPI)positive infertility patients and antibody negative patients),to explore the relations between antibodies positive and patients' adverse pregnancy rates as well as spontaneous abortion frequency.All the antibody positive patients are given individualized drug therapy before acquiring eggs or transplanting embryos.Under fresh embryo transplant conditions,by comparing the number of mature eggs,2PN embryos,high quality embryo,to analyse the affection of ACA and/or a?2-GPI positive to the eggs and embryos'quality.In view of the characteristics of both embryo transfer cycles,1309 cycles was divided into two groups-fresh embryo transplantation cycles and frozen embryo transplantation cycles,after embryos transferring,calculate ACA and/or a?2-GPI positive patients and negative patients',clinical pregnancy rate,miscarriage rate and the final number of live births under three conditions(fresh cycles,frozen cycles and whole cycles)respectively.MethodsA retrospective analysis of 1309 transplant cycles from 955 infertility patients who received in vitro fertilization-embryo transfer treatment from September 2017 to March 2018 in the Reproductive Medicine Center of Qilu Hospital.The concentration of anti-a?2-GP1 antibody(IgG or IgM or IgA)?20RU/ml or ACA-(IgG or IgM or IgA)concentration?12U/ml is defined as positive,that is,if one of the six indicators of the patient is greater than or equal to one indicator,the patient will be defined antibody positive.In this study,adverse pregnancy refers to inevitable abortion caused by early embryonic cessation during pregnancy,exclude other specific causes(external force impact,specific diseases,etc.),or premature before 34 weeks pregnancy due to severe pre-eclampsia or placental function recession.By comparing basic characteristics(age,BMI,FSH,LH,E2,AMH,TSH)of ACA and/or a?2-GPI positive patients and antibody-negative patients,to find whether there was heterogeneity between the two groups of patients.The rates of adverse pregnancies and the number of spontaneous abortions in the two groups were compared to investigate whether there was any correlation between antibody positive and the patient's previous adverse pregnancy history;for ACA and/or a 3 2-GPI positive patients were given individualized interventions before embryo transfer.In order to explore the connection between ACA and/or a?2-GPI positive and the outcome of in vitro fertilization-embryo transfer,the clinical pregnancy rate,spontaneous abortion rate,and live birth numbers of the two groups were counted.Individualized treatment for antibody-positive patients means:under the condition of fresh transplantation,30 days before the patient gets the eggs,give low-dose aspirin(50-100mg/d)+ prednisone(5mg/d),when controlled ovulation induction initiates,stop taking these medicine.on the 2nd day after the patients obtain the egg,began to take low-dose aspirin(50-1 00mg/d)+ prednisone(5mg/d)+inject low molecular weight heparin sodium(2000-4000U)/d subcutaneously.Under the condition of frozen embryo transfer cycle,patients were given low-dose aspirin(50-100mg/d)+ prednisone(5mg/d)15-30 days before embryo transfer,after embryo transfer,low molecular weight heparin Sodium(2000-4000 U/d)is added.Oral immunosuppressants(hydroxychloroquine,cyclosporine,etc.)may be administered as appropriate for those who have had a history of thrombosis,an abnormal increase in antibody titer,or have had multiple adverse pregnancy history.In view of different cycle types,embryo transfer time and medication are different,which may affect the implantation rate and clinical pregnancy rate after embryo transfer.Therefore,ACA and/or a?2-GPI positive patients and antibody-negative patients are each divided into two subgroups depending on the type of cycle.By comparing the general characteristics of ACA and/or a?2-GPI positive patients and antibody negative patients under the conditions of two transplantation cycles,to see whether there is any heterogeneity between the two.In order to explore the relationship between the ACA and/or a?2-GPI positive and the quality of eggs as well as embryos,the number of mature eggs,2PN embryos,high-quality embryos are counted After embryos transferring,calculate ACA and/or a?2-GPI positive patients and negative patients' clinical pregnancy rate,miscarriage rate and the final number of live births under three conditions(fresh cycles,frozen cycles and whole cycles)respectively.As of the end of the study,follow the pregnancy complications during the pregnancy of live births,that is,the hypertensive disorder of pregnancy during pregnancy,premature rupture of membranes,oligohydramnios,placental abruption,fetal growth and development limitation.Compare the frequency of total pregnancy complications between ACA and/or a?2-GPI positive and antibody-negative patients,to find whether there is statistical difference between the two,and the frequency of occurrence of each of the five pregnancy complications and the composition ratio within the group are compared between the two groups.SPSS19.0 statistical software was selected for statistical analysis of the data.The resultsr of the measurement data were expressed as mean± standard deviation(X±S).The data of the normal distribution between the two groups were compared by independent sample t test,and the two groups were non-normally distributed.The inter-data comparisons were performed using a nonparametric rank sum test.The results were expressed as percentages(%),and the ratios were compared using the x^2 test.P<0.05 indicated that the difference was statistically significant.Results1.Statistical analysis of ACA and/or a?2-GPI positive patients and antibody-negative patients with adverse pregnancy and spontaneous abortion,the two have statistically significant differences(P<0.05),antibody-positive patients have higher rates of adverse pregnancy and spontaneous abortion than antibody-negative patients.For ACA and/or a 32-GPI positive patients,after giving individualized drug intervention,to count the clinical pregnancy rate and spontaneous abortion rate after embryo transfer in the two groups.The rates of clinical pregnancy and spontaneous abortion show no significant difference in the two groups(p>0.05).But the number of live births in antibody-positive patients was lower than that in antibody-negative patients,and the difference was statistically significant(p<0.05).2.For ACA and/or a?2-GPI positive patients,after giving individualized drug intervention,under fresh embryo transfer condition,comparing the number of mature eggs,2PN embryos and high-quality embryos,there is no significant difference in the two groups(P>0.05).After embryos transferring,count the clinical pregnancy rate and spontaneous abortion rate in the two groups.The rates of clinical pregnancy and spontaneous abortion show no significant difference in the two groups(p>0.05).But the number of live births in antibody-positive patients was lower than that in antibody-negative patients,and the difference was statistically significant(p<0.05).3.Under the conditions of frozen embryo transfer,ACA and/or a?2-GPI positive patients undergo embryo transfer after individualized intervention,there was no significant difference in pregnancy rate and spontaneous abortion rate between the negative patients(P>0.05),but the live births of antibody positive patients were lower than those of antibody negative patients,the difference was statistically significant(P<0.05).4.patients who received live birth before the deadline have been followed.The incidence of total complications in the ACA and/or a?2-GPI positive patients was high,and the difference was statistically significant(P<0.05).Among antibody-positive patients,the incidence of hypertensive disorder complicating pregnancy and fetal growth and development were high,and the difference was statistically significant(p<0.05).The incidence of total pregnancy complications in antibody-negative patients is low,due to the small follow-up sample,the statistical bias is large,we won't elaborate it overly.Conclusions1.ACA and/or a?2-GPI positive associates with adverse pregnancy outcomes,it can cause early embryonic arrest,spontaneous abortion.2.Under the condition of fresh transplantation cycle,ACA and/or a?2-GPI positive patients obtain eggs after individualized treatment,comparing the number of mature eggs obtained,2PN embryos with antibody-negative patients,there was no significant difference.3.Prior to embryo transfer,patients with ACA and/or a?2-GPI positive were given individualized drug treatment.After embryo transferring,the early spontaneous abortion rate of these patients do not increase,and the clinical pregnancy rate was similar to that of antibody-negative patients.And the subgroup results of different cycle types,their clinical pregnancy rate and spontaneous abortion rate after embryo transfer are consistent with the above results.4.Given the small sample size of this study as of the time of writing,the relationship between ACA and/or a?2-GPI positive and the number of live births after embryo transfer still need large sample of follow-up results to confirm it.5.In this study,by following patients who have live births,we find ACA and/or a?2-GPI positive patients' incidence of pregnancy complications is higher than antibody-negative patients,and mainly expressed as high incidence hypertension and fetal growth and development limitation. |
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