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A total of 14,254 women (mean age, 33.1 years; range, 20–50 years) who were referred to the reproductive center between January 1 and December 31, 2017, were enrolled in this study (Figure 1 and Supplementary Figure S1 available in www.besjournal.com). Based on CXR findings, 1,487 (10.4%) had signs of prior PTB and were assigned to the prior PTB group, whereas 12,767 (89.6%) were assigned to the non-PTB group. In the prior PTB group, 248 (16.7%) were excluded because of a history of anti-TB therapy, and the remaining 1,239 (83.3%) patients without such a history were assigned to the untreated prior PTB group. One patient in the untreated PTB group had a fever at 12 weeks of pregnancy and was confirmed to have acute miliary TB. Pregnancy was terminated due to spontaneous abortion.
We compared the baseline characteristics of patients in the untreated prior PTB (n = 1,239) and non-PTB (n = 12,767) groups who had received COH (Supplementary Table S1 available in www.besjournal.com). We also compared patients in the untreated prior PTB (n = 791) and non-PTB (n = 7,807) groups who had received ET (Table 1). The results of the comparative analysis for these two groups were similar (Table 1 and Supplementary Table S1). Patients in the untreated prior PTB group were older (34.8 ± 5.0 vs. 33.0 ± 5.0 years), had longer infertile periods (4.6 ± 4.0 vs. 4.3 ± 3.7), and had lower BMI values (22.6 ± 3.5 vs. 23.1 ± 3.8) than those in the non-PTB group (all P < 0.05; Table 1). Tubal factors were the most common cause of infertility in both groups, and the proportion of tubal factors as an infertility cause was higher in the untreated prior PTB group than in the non-PTB group. The untreated prior PTB group had lower numbers of total follicles (10.1 ± 5.4 vs. 11.1 ± 5.5), retrieved oocytes (9.3 ± 4.9 vs. 10.0 ± 5.2), and good-quality embryos per cycle compared with the non-PTB group [3.0 (1.0, 5.0) vs. 3.0 (2.0, 6.0); all P < 0.05; Table 1].
Characteristics Untreated Prior-PTB Group (n = 1,239) Non-PTB Group (n = 12,767) P Value Age (years) 34.4 ± 5.2 32.9 ± 5.1 < 0.001* Body mass index, kg/m2 22.5 ± 3.6 22.9 ± 3.7 < 0.001* Duration of infertility (years) 4.8 ± 4.1 4.2 ± 3.7 < 0.001* Causes of infertility, no. (%) 0.005* Female factors Fallopian tube factor 345 (23.2) 2,312 (18.1) PCOS 133 (10.8) 1,391 (10.9) Endometriosis 18 (1.5) 179 (1.4) Mixed female factors 178 (14.4) 1,542 (12.1) Other female factors 46 (3.7) 590 (4.6) Male factors Oligospermia/asthenospermia 131 (10.6) 1,549 (12.1) Other male factors 62 (5.0) 2,312 (18.1) Mixed female and male factors 281 (22.7) 2,778 (21.8) Unexplained infertility 131 (10.6) 1,570 (12.3) COH protocol < 0.01* Ultralong GnRH agonist 125 (10.1) 1,433 (11.2) Short GnRH agonist 47 (3.8) 417 (3.3) GnRH antagonist 633 (51.1) 6,730 (52.7) Microsimulation cycle 82 (6.6) 512 (4.0) Long GnRH agonist 339 (27.4) 3,498 (27.4) Natural or other 13 (1.0) 177 (1.4) Basic hormone FSH, mIU/mL 6.3 (4.6–8.3) 6.2 (4.6–7.9) 0.024* LH, mIU/mL 3.2 (2.0–4.9) 3.3 (2.0–5.0) 0.197 E2, pg/mL 156.0 (117.0–200.0) 158.0 (119.0–203.0) 0.440 P, nmol/L 1.0 (0.8–1.4) 1.1 (0.8–1.5) 0.289 AMH, ng/mL 2.2 (1.0–4.2) 2.4 (1.1–4.5) 0.051 Total sinus follicles 10.7 ± 6.0 11.8 ± 5.9 < 0.001* No. of retrieved oocytes 11.0 ± 7.4 12.2 ± 8.2 < 0.001* Note. Mixed female factors, mixed with two or more female infertile factors. Mixed female and male factors, mixed with two or more infertile factors of both sexes.
Abbreviations: PTB, pulmonary tuberculosis; BMI, body mass index; PCOS, polycystic ovary syndrome; COH, controlled ovarian hyperstimulation; FSH, follicle-stimulating hormone; LH, luteinizing hormone; E2, estradiol; P, prolactin; AMH, anti-Müllerian hormone.
*P < 0.05.Table S1. Characteristics of the total infertile patients at baseline
Characteristics Untreated prior-PTB group (n = 791) Non-PTB group (n = 7,807) P value Age (years) 34.8 ± 5.0 33.0 ± 5.0 < 0.001a BMI, kg/m2 22.6 ± 3.5 23.1 ± 3.8 < 0.001a Duration of infertility (years) 4.6 ± 4.0 4.3 ± 3.7 0.017a Causes of infertility, no. (%) 0.081 Female factors Fallopian tube factor 185 (23.4) 1,582 (20.3) PCOS 60 (9.8) 799 (10.3) Endometriosis 10 (1.3) 108 (1.4) Mixed female factors 113 (14.3) 906 (11.6) Other female factors 20 (2.5) 241 (3.1) Male factors Oligospermia/asthenospermia 92 (11.6) 1,023 (13.1) Other male factors 39 (4.9) 512 (6.6) Mixed female and male factors 170 (21.5) 1,682 (21.5) Unexplained infertility 84 (10.6) 954 (12.2) COH protocol 0.034a Ultralong GnRH agonist 85 (10.7) 939 (12.0) Short GnRH agonist 31 (3.9) 251 (3.2) GnRH antagonist 404 (51.1) 4,119 (52.8) Microsimulation cycle 39 (4.9) 227 (2.9) Long GnRH agonist 228 (28.8) 2,225 (28.5) Natural or other 4 (0.5) 46 (0.6) Baseline hormone FSH, mIU/mL 6.3 (4.6–8.2) 6.3 (4.7–7.9) 0.328 LH, mIU/mL 3.1 (1.9–4.6) 3.2 (2.0–4.7) 0.191 E2, pg/mL 156.0 (119.0–202.0) 158.0 (120.0–203.0) 0.582 P, nmol/L 1.0 (0.8–1.4) 1.1 (0.8–1.5) 0.040a AMH, ng/mL 2.1 (1.1–3.5) 2.2 (1.1–3.9) 0.143 No. of total sinus follicles 10.1 ± 5.4 11.1 ± 5.5 < 0.001a No. of retrieved oocytes 9.3 ± 4.9 10.0 ± 5.2 < 0.001a Endometrial thickness (mm) 10.78 ± 1.71 10.74 ± 1.75 0.534 Endometrial pattern 0.095 A 702 (88.7) 6,721 (86.1) A–B 3 (0.4) 34 (0.4) B 77 (9.7) 991 (12.7) C 0 (0.0) 2 (0.0) No. of good-quality embryos per cycleb 3.0 (1.0, 5.0) 3.0 (2.0, 6.0) < 0.001a No. of embryos transferred < 0.001a 1 154 (19.6) 1,161 (15.0) 2 630 (80.4) 6,593 (85.0) Note. Mixed female factors, mixed with two or more female infertile factors. Mixed female and male factors, mixed with two or more factors of infertility of both sexes.
ET, embryo transfer; BMI, body mass index; PTB, pulmonary tuberculosis; PCOS, polycystic ovary syndrome; COH, controlled ovarian hyperstimulation; GnRH, gonadotropin-releasing hormone; FSH, follicle-stimulating hormone; LH, luteinising hormone; E2, oestradiol; P, prolactin; AMH, anti-Müllerian hormone.
aP < 0.05.
bEmbryos were evaluated on the third day after fertilization. All good-quality embryos were developed from two pronuclei zygotes and met the following criteria: (1) more than five blastomeres; (2) size difference of less than 20%; and (3) fragmentation of less than 50%.
Data on BMI, endometrial thickness, endometrial pattern, and number of embryos transferred were missing for 80 cases, 1,418 cases, 68 cases, and 60 cases, respectively, in the general research population.Table 1. Characteristics of infertile patients who underwent ET cycles
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The clinical pregnancy rate was significantly lower in the untreated prior PTB group than in the non-PTB group (31.7% vs. 38.1%, P < 0.001). The miscarriage rate was slightly higher in the prior PTB group than in the non-PTB group; however, the difference was not significant (19.1% and 15.5%, P = 0.135). Additionally, the live birth rate was significantly lower in the untreated prior PTB group than in the non-PTB group (23.8% vs. 30.6%, P < 0.001; Table 2).
Pregnancy outcomes Untreated prior-PTB group Non-PTB group P value Clinical pregnancy ratea 31.7% (251/791) 38.1% (2,973/7,807) < 0.001d Miscarriage rateb 19.1% (48/251) 15.5% (462/2,973) 0.135 Live birth ratec 23.8% (186/782) 30.6% (2,375/7,768) < 0.001d Note. PTB, pulmonary tuberculosis.
aClinical pregnancy rate was defined as clinical pregnancy per embryo transfer.
bMiscarriage rate was defined as miscarriages per clinical pregnancy.
cLive birth rate was defined as live birth per embryo transfer.
dP < 0.05.Table 2. Pregnancy outcomes in the untreated prior-PTB and non-PTB groups
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The results indicated that age, BMI, COH protocol, endometrial thickness, and number of good-quality embryos per cycle had significant effects on the clinical pregnancy, miscarriage, and live birth rates (Supplementary Table S2 available in www.besjournal.com). After adjustment for these factors, the results indicated that untreated prior PTB was an independent risk factor for decreased live birth rate (OR, 0.80; 95% CI, 0.66–0.98; P = 0.028) in infertile patients (Table 3 and Supplementary Table S2). Patients with untreated prior PTB tended to have fewer clinical pregnancies and more miscarriages than non-PTB patients; nonetheless, the differences were not statistically significant (P = 0.119 and 0.214, respectively; Table 3 and Supplementary Table S2).
Outcomes Variables OR (95% CI) P value Clinical pregnancy (n = 8,593) Untreated prior-PTB vs. non-PTB group 0.87 (0.72–1.04) 0.119 Age < 0.001* 31–35 years vs. ≤ 30 years 0.96 (0.86–1.08) 0.492 36–40 years vs. ≤ 30 years 0.59 (0.51–0.69) < 0.001* 41–45 years vs. ≤ 30 years 0.25 (0.19–0.32) < 0.000* ≥ 46 years vs. ≤ 30 years 0.08 (0.02–0.25) < 0.001* BMI 0.99 (0.98–1.00) 0.161 Endometrial thickness 1.08 (1.05–1.12) < 0.001* No. of good-quality embryos per cycle 1.10 (1.08–1.12) < 0.001* COH protocol < 0.001* Ultralong GnRH agonist vs. natural 1.32 (0.50–3.47) 0.578 Long GnRH agonist vs. natural 0.86 (0.32–2.35) 0.773 Short GnRH agonist vs. natural 0.82 (0.31–2.14) 0.684 GnRH antagonist vs. natural 1.10 (0.40–3.01) 0.852 Microsimulation cycle vs. natural 1.18 (0.45–3.08) 0.743 Infertile causes 0.177 Unexplained infertility vs. PCOS 1.23 (0.99–1.54) 0.068 Mixed female factors vs. PCOS 0.91 (0.72–1.15) 0.441 Mixed female and male factors vs. PCOS 1.04 (0.85–1.28) 0.715 Oligospermia/asthenospermia vs. PCOS 1.13 (0.91–1.40) 0.283 Other male factors vs. PCOS 0.95 (0.68–1.33) 0.763 Other female factors vs. PCOS 1.01 (0.78–1.31) 0.944 Fallopian tube factor vs. PCOS 1.13 (0.92–1.38) 0.263 Endometriosis 0.95 (0.60–1.50) 0.826 Miscarriage (n = 3,222) Untreated prior-PTB vs non-PTB group 1.26 (0.87–1.83) 0.214 Age < 0.001* 31–35 years vs. ≤ 30 years 1.07 (0.83–1.39) 0.596 36–40 years vs. ≤ 30 years 2.38 (1.76–3.21) < 0.001* 41–45 years vs. ≤ 30 years 5.36 (3.22–8.93) < 0.001* ≥ 46 years vs. ≤ 30 years − 0.999 BMI 1.03 (1.00–1.06) 0.048 Endometrial thickness 0.92 (0.87–0.99) 0.019* No. of good-quality embryos per cycle 0.98 (0.95–1.02) 0.365 COH Protocol 0.315 Ultralong GnRH agonist vs. natural 0.27 (0.05–1.41) 0.119 Long GnRH agonist vs. natural 0.45 (0.08–2.56) 0.370 Short GnRH agonist vs. natural 0.29 (0.06–1.50) 0.139 GnRH antagonist vs. natural 0.20 (0.03–1.21) 0.080 Microsimulation cycle vs. natural 0.29 (0.06–1.52) 0.144 Infertile causes 0.237 Unexplained infertility vs. PCOS 1.31 (0.81–2.10) 0.269 Mixed female factors vs. PCOS 1.47 (0.90–2.42) 0.128 Mixed female and male factors vs. PCOS 0.99 (0.63–1.55) 0.958 Oligospermia/asthenospermia vs. PCOS 1.05 (0.65–1.71) 0.831 Other male factors vs. PCOS 1.62 (0.83–3.15) 0.156 Other female factors vs. PCOS 1.21 (0.67–2.18) 0.523 Fallopian tube factor vs. PCOS 0.96 (0.61–1.52) 0.865 Endometriosis 1.84 (0.76–4.49) 0.178 Live birth (n = 8,545) Untreated prior-PTB vs. non-PTB group 0.80 (0.66–0.98) 0.028* Age < 0.001* 31–35 years vs. ≤ 30 years 0.95 (0.84–1.07) 0.413 36–40 years vs. ≤ 30 years 0.50 (0.43–0.59) < 0.001* 41–45 years vs. ≤ 30 years 0.17 (0.12–0.23) < 0.001* ≥ 46 years vs. ≤ 30 years − 0.997 BMI 0.98 (0.97–1.00) 0.009* Endometrial thickness 1.11 (1.08–1.15) < 0.001* No. of good-quality embryos per cycle 1.09 (1.07–1.11) < 0.001* COH Protocol < 0.001* Ultralong GnRH agonist vs. natural 2.05 (0.59–7.15) 0.262 Long GnRH agonist vs. natural 1.16 (0.32–4.18) 0.826 Short GnRH agonist vs. natural 1.32 (0.38–4.57) 0.664 GnRH antagonist vs. natural 1.93 (0.53–6.97) 0.319 Microsimulation cycle vs. natural 1.87 (0.54–6.51) 0.324 Infertile causes 0.073 Unexplained infertility vs. PCOS 1.20 (0.95–1.53) 0.131 Mixed female factors vs. PCOS 0.86 (0.67–1.11) 0.250 Mixed female and male factors vs. PCOS 1.08 (0.86–1.35) 0.522 Oligospermia/asthenospermia vs. PCOS 1.15 (0.91–1.46) 0.237 Other male factors vs. PCOS 0.88 (0.61–1.28) 0.505 Other female factors vs. PCOS 1.01 (0.77–1.34) 0.924 Fallopian tube factor vs. PCOS 1.17 (0.93–1.46) 0.180 Endometriosis 0.93 (0.57–1.52) 0.768 Note. Abbreviations: PTB, pulmonary tuberculosis; BMI, body mass index; PCOS, polycystic ovary syndrome; COH, controlled ovarian hyperstimulation; PCOS, polycystic ovary syndrome.
*P < 0.05.Table S2. Multivariate logistic regression analyses for pregnancy outcomes
Variable Clinical pregnancy rate (n = 8,598) Miscarriage rate (n = 3,222) Live birth rate (n = 8,545) OR (95% CI) P value OR (95% CI) P value OR (95% CI) P value Untreated prior PTB vs. non-PTB 0.87 (0.72–1.04) 0.119 1.26 (0.87–1.83) 0.214 0.80 (0.66–0.98) 0.028a Note. Factors were adjusted for age, BMI, infertile causes, controlled ovarian hyperstimulation protocol, endometrial thickness, and number of good-quality embryos per cycle.
OR, odds ratio; CI, confidence interval; PTB, pulmonary tuberculosis; BMI, body mass index.
aP < 0.05.Table 3. Multivariable logistic regression analyses for pregnancy outcomes
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In the UI subgroup, untreated prior PTB was shown to be a risk factor for increased miscarriage (OR, 4.19; 95% CI, 1.69–10.39; P = 0.002) and decreased live birth (OR, 0.45; 95% CI, 0.24–0.83; P = 0.011) rates (Table 4).
Different infertile populations Clinical pregnancy rate Miscarriage rate Live birth rate n OR P value n OR P value n OR P value General research population 7,167 0.87 (0.72, 1.04) 0.119 2,703 1.26 (0.87, 1.83) 0.214 7,124 0.80 (0.66, 0.98) 0.028a Fallopian tube factor 1,459 0.75 (0.52, 1.08) 0.124 595 1.14 (0.51, 2.53) 0.753 1,445 0.68 (0.46, 1.02) 0.059 PCOS 697 1.04 (0.55, 1.94) 0.912 205 1.38 (0.36, 5.27) 0.637 693 0.81 (0.39, 1.70) 0.576 Endometriosis 101 1.10 (0.17, 6.94) 0.923 37 – 0.999 101 1.90 (0.27, 13.46) 0.520 Oligospermia/asthenospermia 1,008 0.61 (0.36, 1.01) 0.054 421 1.43 (0.43, 4.77) 0.561 1,001 0.62 (0.36, 1.08) 0.092 Unexplained infertility 915 0.73 (0.44, 1.22) 0.229 381 4.19 (1.69, 10.39) 0.002a 911 0.45 (0.24, 0.83) 0.011a Mixed female factors 779 1.13 (0.66, 1.92) 0.667 250 0.36 (0.09, 1.44) 0.148 774 1.42 (0.81, 2.51) 0.224 Mixed female and male factors 1,522 1.03 (0.70, 1.53) 0.874 548 0.99 (0.41, 2.40) 0.981 1,516 1.09 (0.71, 1.67) 0.682 Other female factors 221 2.02 (0.65, 6.24) 0.224 77 4.52 (0.62, 33.25) 0.138 219 0.75 (0.20, 2.77) 0.661 Other male factors 465 0.86 (0.38, 1.93) 0.708 189 1.28 (0.23, 6.95) 0.778 464 0.83 (0.35, 1.97) 0.680 Note. Factors were adjusted for age, BMI, and controlled ovarian hyperstimulation protocol. OR, odds ratio; PTB, pulmonary tuberculosis; BMI, body mass index. PCOS, polycystic ovary syndrome; aP < 0.05.
Data on BMI, endometrial thickness, endometrial pattern, and number of embryos transferred were missing for 80, 1,418, 68, and 60 cases, respectively, in the general research population.Table 4. Correlation analysis between untreated prior PTB revealed by chest X-ray and pregnancy outcomes in different infertile populations
Untreated Prior Pulmonary Tuberculosis Adversely Affects Pregnancy Outcomes in Infertile Women Undergoing in vitro Fertilization and Embryo Transfer: A Large Retrospective Cohort Study
doi: 10.3967/bes2021.019
- Received Date: 2020-11-03
- Accepted Date: 2021-01-22
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Key words:
- Tuberculosis /
- Embryo transfer /
- In vitro fertilization /
- Infertility /
- Pregnancy outcome
Abstract:
Citation: | GAI Xiao Yan, CHI Hong Bin, ZENG Lin, CAO Wen Li, CHEN Li Xue, ZHANG Chen, LU Ming, NING Lan Ding, CHANG Chun, ZHANG Wei Xia, LIU Ping, LI Rong, SUN Yong Chang, QIAO Jie. Untreated Prior Pulmonary Tuberculosis Adversely Affects Pregnancy Outcomes in Infertile Women Undergoing in vitro Fertilization and Embryo Transfer: A Large Retrospective Cohort Study[J]. Biomedical and Environmental Sciences, 2021, 34(2): 130-138. doi: 10.3967/bes2021.019 |