Objective: To explorer factors related to spontaneous reduction in twin pregnancy following assisted reproductive technology. Methods: 2 848 twin pregnant women with treatment of vitro fertilization-embryo transfer (IVF-ET) or intra cytoplasmic sperm injection (ICSI) cycles were enrolled at Assisted Reproductive Centre of the First Affiliated Hospital of Nanjing Medical University, Nanjing Maternity Hospital and Shengjing Hospital of China Medical University from January 2013 to December 2016 respectively. Basic features of subjects, relevant clinical indicators, factors of assisted reproductive therapy and pregnancy outcome were collected from clinical assisted reproductive technology management system. According to the pregnancy outcome, the subjects with spontaneous reduction were classified as case group (n=686), and those with normal twin birth were classified as control group (n=2 162). The features of subjects in the two groups were compared. Non-conditional logistics regression model was used to analyze the related factors of the occurrence of spontaneous reduction. Results: The age of case group and control group were (30.6±4.3) and (30.2±4.0) years old respectively. After the adjustment of male sterile factor, compared to the subjects with luteinizing hormone level on the day of human chorionic gonadotropin administration (HCG) <1.43 IU/L, OR (95%CI) of the subjects with value at 2.59-5.10 IU/L was1.62 (1.08-2.42).Compared to the subjects with number of transferred embryo as 1, OR (95%CI) of the subjects with value as 3 was 0.23 (0.07-0.74). Compared to the subjects with stage of transferred embryo as cleavage stage, OR (95%CI) of the subjects with blastula stage was 0.42 (0.27-0.67). Conclusion: Luteinizing hormone level on day of HCG, number and stage of embryo transfer are related factors to spontaneous reduction in twin pregnancy following assisted reproductive technology.
目的： 探索辅助生殖双胎妊娠发生自然减胎的相关因素。 方法： 选取2013年1月至2016年12月在南京医科大学第一附属医院、南京市妇产医院和中国医科大学附属盛京医院辅助生殖中心实施体外受精-胚胎移植或单精子卵胞浆内注射的2 848例患者，从辅助生殖管理系统获取研究对象的基本特征、相关临床检测指标、辅助生殖治疗因素和妊娠结局。按照妊娠结局将自然减胎者作为病例组（686例），正常双胎分娩者作为对照组（2 162名），对两组孕妇特征进行比较，采用多因素非条件logistic回归模型分析自然减胎的相关因素。 结果： 病例组和对照组年龄分别为（30.6±4.3）和（30.2±4.0）岁。调整男方不育因素后，与人绒毛膜促性腺激素注射日的促黄体生成素水平<1.43 IU/L者相比，2.59~5.10 IU/L者发生自然减胎风险的OR（95%CI）值为1.62（1.08~2.42）；与移植胚胎数为1者相比，移植胚胎数为3者发生自然减胎风险的OR（95%CI）值为0.23（0.07~0.74）；与移植胚胎类型为卵裂期者相比，囊胚期者发生自然减胎风险的OR（95%CI）值为0.42（0.27~0.67）。 结论： 人绒毛膜促性腺激素注射日的促黄体生成素水平、移植胚胎数量和类型是辅助生殖双胎妊娠自然减胎的相关因素。.
Keywords: Embryo transfer; Fertilization in vitro; Related factors; Spontaneous reduction.