Lingmin Hu, Jiangbo Du, Hong Lv, Jing Zhao, Mengxi Chen, Yifeng Wang, Fang Wu, Feng Liu, Xiaojiao Chen, JunqiangZhang, Hongxia Ma, Guangfu Jin, Hongbing Shen, Li Chen, Xiufeng Ling, Zhibin Hu
Abstract
Background: Pregnanciesfollowing assisted reproductive technology (ART) may have elevated potentialrisk of pregnancy loss (PL) when compared to natural conception. However, rarestudies comprehensively analyzed the IVF/ICSI cycle-dependent factors for lossof clinical pregnancy. Therefore, we aimed to determine the ARTsubgroup-specific risks of PL throughout pregnancy and explore different riskfactors for early miscarriage and late miscarriage among pregnancies conceivedthrough ART.
Methods: Aretrospective cohort study was launched in two infertility treatment centers inNanjing and Changzhou including 5485 IVF/ICSI embryo transfer cycles with knownoutcomes after clinical pregnancy by the end of 2015. Cox proportional hazardsregression analysis was performed to estimate the hazard ratios and their 95%confidence intervals. The associations between survival time during pregnancyand demographics and clinical characteristics of clinical pregnancies wereestimated using the Kaplan-Meier method and the Log-rank test.
Results: Theoverall PL rate in current ART population was 12.5%. Among the 685 pregnancyloss cycles, a total of 460 ended as early miscarriage, 191 as latemiscarriage. We found couples in ART pregnancies demonstrated a significantlyincreased risk of PL as maternal age (HR = 1.31, Ptrend < 0.001) grows.Pregnancies received controlled ovarian hyperstimulation (COH) protocol likeGnRH antagonist protocol (HR = 3.49, P < 0.001) and minimal stimulationprotocol (HR = 1.83, P < 0.001) had higher risk of PL than GnRH-a longprotocol. Notably, in contrast to fresh cycle, women who received frozen cycleembryo had a significant increased risk of early miscarriage (P < 0.001),while frozen cycle was linked with lower risk of late miscarriage (P = 0.045).In addition, four factors (maternal age, COH protocol, cycle type and serum hCGlevel 14 days after transfer) had independent impact on miscarriage mainlybefore 12 weeks of gestational age.
Conclusions: Withthese findings in this study, clinicians may make it better to evaluate apatient's risk of PL based on the maternal age at the time of treatment, COHprotocol, cycle type and serum hCG level 14 days after transfer and thegestational week of the fetus, and we hope that it contributes to future studyon its etiology and guide the clinical prevention and treatment.
Keywords: Abortion; Assisted;Kaplan-Meier estimate; Reproductive techniques; Spontaneous
引用本文：
Hu L, Du J, Lv H, Zhao J, Chen M, Wang Y, Wu F, Liu F, Chen X, Zhang J, Ma H, Jin G, Shen H, Chen L, Ling X, Hu Z. Influencing factors of pregnancy loss and survival probability of clinical pregnancies conceived through assisted reproductive technology. Reprod Biol Endocrinol. 2018 Aug 7;16(1):74. doi: 10.1186/s12958-018-0390-6. PMID: 30086781; PMCID: PMC6081896.
