1.Center of Clinical Reproductive Medicine,First Affiliated Hospital of Nanjing University,Nanjing,210029;2.China
目的：探讨体外受精/卵胞质内单精子注射（in vitro fertilization/intracytoplasmic sperm injection, IVF/ICSI）助孕的女性体重指数（body mass index, BMI）对鲜胚移植周期临床结局的影响。方法：回顾性分析2016年6月—2018年6月在本中心首次IVF/ICSI治疗并行单个鲜胚移植的1 784例患者临床资料，按照BMI值（中国标准）分为偏瘦组（150例，BMI＜18.5 kg/m2）、正常组（1098例，18.5 kg/m2≤BMI＜24.0 kg/m2）、超重组（437例，24.0 kg/m2≤BMI＜28 kg/m2）、肥胖组（99例，BMI≥28 kg/m2），并以不同受精方式分为IVF亚组和ICSI亚组。比较新鲜周期的获卵数、临床妊娠率、种植率、活产率、流产率的区别，以及各亚组间受精率和优质胚胎率的差异。结果：4组的获卵数分别为（6.9 ± 2.8 vs 6.1 ± 3.0 vs 6.0 ± 3.5 vs 4.8 ± 3.0），偏瘦组获卵数显著高于正常组、超重组和肥胖组，正常组、超重组获卵数均显著高于肥胖组（P＜0.01）；4组的临床妊娠率、种植率分别为（42.7% vs 47.4% vs 40.7% vs 37.4%；40.0% vs 46.9% vs 40.3% vs 36.4%），具有统计学差异（P＜0.05），正常组的临床妊娠率显著高于超重组，正常组的种植率显著高于超重组和肥胖组（P＜0.05）；4组的活产率、流产率均没有统计学差异（P＞0.05）；4组患者的IVF亚组和ICSI亚组的受精率、优质胚胎率均没有统计学差异（P＞0.05）。结论：女性肥胖对IVF/ICSI周期的治疗结局有显著的负面影响。与BMI正常的女性相比，超重和肥胖女性鲜胚移植周期的种植率显著下降。
Objective: To investigate the effect of female body mass index (BMI) on the outcomes of IVF/ICSI cycles after fresh embryo transfer. Methods: The data of 1784 cycles , which were accomplished with single fresh embryo transfer in the first IVF/ICSI treatment, are analyzed retrospectively, the cycles were divided into four groups according to the recommended Chinese BMI cut-off: underweight (150 cycles, BMI<18.5 kg/m2), normal weight (1098 cycles, 18.5 kg/m2 ≤ BMI < 24.0 kg/m2), overweight (437 cycles, 24.0 kg/m2 ≤ BMI < 28 kg/m2), obese (99 cycles, BMI ≥ 28 kg/m2), and the cycles were also subdivided into IVF and ICSI group by different insemination methods. We compared the number of oocytes, clinical pregnancy rates, implantation rates, live birth rates, miscarriage rates among the four groups, and also compared the fertilization rates and the high quality embryo rates among the subgroups. Results: The number of oocytes retrieved in the four groups were (6.9 ± 2.8 vs 6.1 ± 3.0 vs 6.0 ± 3.5 vs 4.8 ± 3.0), the number of oocytes retrieved in the underweight group was significantly higher than that of the normal weight, overweight and obese groups, and the number of oocytes retrieved in the normal weight group and overweight group was significantly higher than that of the obese group (P < 0.01); the clinical pregnancy and implantation rates in the four groups were (42.7% vs 47.4% vs 40.7% vs 37.4%; 40.0% Vs 46.9% vs 40.3% vs 36.4%), with statistical difference (P < 0.05), The clinical pregnancy rate of normal weight group was significantly higher than that of overweight group, and the implantation rate of normal weight group was significantly higher than that of overweight and obese groups; the live birth and miscarriage rates in the four groups were no significant difference(P > 0.05). There were no significant difference in fertilization rates and high quality embryo rates between the IVF subgroup and the ICSI subgroup(P > 0.05). Conclusions: Female obesity has a significant negative effect on the outcomes of IVF/ICSI cycles. Compared with women with normal BMI, overweight and obese women decreased implantation rates after the fresh embryo transfer.