摘要【目的】探讨体外受精(IVF)患者不孕心理压力和皮质醇(COR)水平的相关性。【方法】选取2018年6月至2020年1月在宝鸡市妇幼保健院生殖中心接受IVF治疗的不孕患者237例。采用生育压力量表(Fertility Problem Inventory,FPI)评估IVF患者的不孕压力评分;采用化学免疫发光分析法检测IVF患者血清COR水平;采用Pearson分析IVF患者的不孕压力与血清COR水平的相关性;采用Logistic回归分析IVF患者妊娠结局的危险因素。【结果】IVF患者不孕压力评分为(183.47±24.27)分,血清COR水平为(4.73±0.26)ng/mL。IVF患者不孕压力评分与血清COR水平呈正相关 (r=0.878,P<0.05)。行IVF治疗的237例不孕患者的总受精率为65.71%,临床妊娠率为51.24%。多因素Logistic回归分析显示:不孕压力和血清COR水平是总受精率与临床妊娠率的影响因素(P<0.05)。【结论】接受IVF治疗患者具有较高的不孕压力和COR水平,且不孕心理压力评分和血清COR水平是IVF患者总受精率与临床妊娠率的影响因素。
Abstract:【Objective】To investigate the correlation between infertility pressure and cortisol level (COR) in women undergoing in vitro fertilization(IVF).【Methods】During June 2016 and January 2018, 237 couples who received IVF or intracytoplasmic sperm injection (ICSI) in our reproductive center were included in the study. Fertility Problem Inventory (FPI) was used to measure the infertility pressure of the subjects. Serum cortisol levels were measured by chemiluminescence assay. Pearson's correlation was used to compare the correlation between infertility pressure and serum cortisol level. Logistic regression was used to analyze the risk factors of pregnancy outcome in IVF patients.【Results】The average age of 237 women was (33.8±4.3) years old. The BMI was (24.14±3.17) kg/m2, and the infertility time was (2.73±1.14) years. The infertility pressure score of IVF patients was (183.47±24.27) points, and the serum COR level was (4.73±0.26) ng/mL. The correlation analysis showed that infertility pressure score was positively correlated with serum cortisol level ( P< 0.05, with Pearson's correlation coefficient r=0.878). The total fertilization rate of 237 infertile patients undergoing IVF treatment was 65.71%, and the clinical pregnancy rate was 51.24%. Multivariate logistic regression analysis showed that aged≥30 years old, smoking, alcohol consumption, high infertility pressure, and high serum cortisol level were independent risk factors for in vitro fertilization and clinical pregnancy failure (P< 0.05). 【Conclusion】Women receiving IVF treatment have higher infertility pressure and cortisol levels. Fertilization rate and clinical pregnancy rate decreased with the increase of infertility pressure and cortisol level.
周鹏飞, 王承秀. 体外受精患者不孕心理压力和皮质醇水平的相关性分析[J]. 医学临床研究, 2021, 38(6): 817-819.
ZHOU Peng-fei, WANG Cheng-xiu. Correlation between Infertility Pressure and Cortisol Level in Women with In Vitro Fertilization. JOURNAL OF CLINICAL RESEARCH, 2021, 38(6): 817-819.
[1] POLIS C B,COX C M, TUNÇALP, et al.Estimating infertility prevalence in low-to-middle-income countries:an application of a current duration approach to emographic and health survey data[J].Hum Reprod,2017, 32(5):1064.
[2] MATTHIESEN S M, FREDERIKSEN Y, INGERSLEV H J, et al.Stress, distress and outcome of assisted reproductive technology (ART):a meta-analysis[J].Hum Reprod,2011, 26(10):2763-2776.
[3] LEVIN K K.Psychological distress in women presenting for first-time in vitro fertilization:Relationships among maternal identity centrality, grief, and psychopathology[J].Fertil Steril,2015, 104(3):e360-e361.
[4] FREDERIKSEN Y, FARVER-VESTERGAARD I.Efficacy of psychosocial interventions for psychological and pregnancy outcomes in infertile women and men:A systematic review and meta-analysis[J].BMJ Open,2015, 5(1):e006592.
[5] MASSEY A J.The association of physiological cortisol and IVF treatment outcomes:a systematic review[J].Reprod Med Biol,2014, 13(4):161-176.
[6] 吴锦.针灸对IVF-ET患者心理压力和子宫内膜蠕动波影响的研究[D].衡阳:南华大学,2017.
[7] 秦凤.子宫内膜异位症患者血浆皮质醇浓度、感知压力水平、生活质量的研究[D].天津:天津医科大学,2018.
[8] 李沛.不孕女性心理状态与体外受精—胚胎移植助孕结局的相关性分析[D].南昌:南昌大学, 2016.
[9] 周飞京, 董悦芝.不孕女性心理压力对体外受精—胚胎移植妊娠结局的影响[J].医学与哲学, 2015, 36(18):59-60.
[10] NOURI K, LITSCHAUER B, HUBER J C, et al.Saliva cortisol levels and subjective stress are not associated with number of oocytes after controlled ovarian hyperstimulation in patients undergoing in vitro fertilization[J].Fertil Steril,2011, 96(1):69-72.
[11] MASSEY A J, CAMPBELL B K, RAINE-FENNING N, et al.Relationship between hair and salivary cortisol and pregnancy in women undergoing IVF[J].Psychoneuroendocrinology,2016, 74:397-405.