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目的 研究子宫内膜厚度对子宫腺肌病患者IVF/ICSI胚胎移植后妊娠结局的影响。方法 回顾性研究2015年1月至2022年1月于西北妇女儿童医院生殖中心以子宫腺肌病为不孕因素之一行IVF/ICSI胚胎移植患者的1 100个治疗周期的临床资料。经阴道超声测量患者新鲜移植周期扳机日或冻融移植周期黄体酮给药日的子宫内膜厚度，根据子宫内膜厚度分为<6.0 mm组(n=13)、6.0～6.9 mm组(n=26)、7.0～7.9 mm组(n=47)、8.0～8.9 mm组(n=141)、9.0～9.9 mm组(n=233)、10.0～10.9 mm组(n=214)、11.0～11.9 mm组(n=176)、12.0～12.9 mm组(n=116)和≥13.0 mm组(n=134),对所有数据进行多元回归分析、曲线拟合和阈值效应分析。结果 对年龄、不孕年限、体质量指数(BMI)、不孕类型、移植胚胎数量和类型调整后，子宫内膜厚度与妊娠率[aOR=1.09,95%CI(1.03,1.17),P<0.05]、临床妊娠率[aOR=1.10,95%CI(1.04,1.17),P<0.05]和活产率[aOR=1.11,95%CI(1.05,1.18),P<0.05]之间存在显著相关性。曲线拟合及阈值效应分析显示：临床妊娠率的子宫内膜厚度临界值为10 mm,当子宫内膜厚度<10 mm时，内膜厚度每增加1 mm,临床妊娠率增加21%[OR=1.21,95%CI(1.05,1.40),P<0.05];活产率的子宫内膜厚度临界值为7.9 mm,当子宫内膜厚度<7.9 mm时，内膜厚度每增加1 mm,活产率增加77%[OR=1.77,95%CI(1.07,2.91),P<0.05]。结论 子宫腺肌病患者IVF/ICSI胚胎移植周期中，当子宫内膜厚度≥7.9 mm时，将获得最佳活产率；如果子宫内膜过薄，活产率将降低。
Abstract：Objective:To evaluate the effect of endometrial thickness on IVF/ICSI pregnancy outcome after embryo transfer in patients with adenomyosis.Methods:The clinical data of 1 100 cycles of the patients with adenomyosis undergone IVF/ICSI-ET treatment at the Center of Assisted Reproductive Technology, Northwest Women's & Children's Hospital from January 2015 to January 2022 were analyzed retrospectively. The endometrial thickness was measured by transvaginal ultrasound on the trigger day in the fresh embryo transfer cycles and on the day of administration of progesterone in the frozen-thawed embryo transfer cycles. All patients were divided into nine groups according to their endometrial thickness, <6.0 mm group(n=13),6.0-6.9 mm group(n=26),7.0-7.9 mm group(n=47),8.0-8.9 mm group(n=141),9.0-9.9 mm group(n=233),10.0-10.9 mm group(n=214),11.0-11.9 mm group(n=176),12.0-12.9 mm group(n=116) and ≥13.0 mm group(n=134),respectively. Multivariate regression analysis, curve fitting and threshold effect analysis were performed on all data.Results:There were the significant correlations between the endometrial thickness and pregnancy rate[aOR=1.09,95%CI(1.03,1.17),P<0.05],clinical pregnancy rate[aOR=1.10,95%CI(1.04,1.17),P<0.05] and live birth rate[aOR=1.11,95%CI(1.05,1.18),P<0.05] after adjusting for the age, duration of infertility, body mass index(BMI),infertility type and number and type of embryos transferred. The curve fitting and threshold effect analysis showed that the numerical value of the cut-off point of clinical pregnancy rate for the endometrial thickness was 10 mm. When the endometrial thickness was less than 10 mm, with each additional 1 mm of endometrial thickness, the clinical pregnancy rate increased by 21%[OR=1.21,95%CI(1.05,1.40),P<0.05]. The numerical value of the cut-off point of live birth rate for the endometrial thickness was 7.9 mm. When the endometrial thickness was less than 7.9 mm, with each additional 1 mm of endometrial thickness, the clinical pregnancy rate increased by 77%[OR=1.77,95%CI(1.07,2.91),P<0.05]. Conclusions:In IVF/ICSI embryo transfer cycles of patients with adenomyosis, the optimal live birth rate would be obtained when the endometrial thickness remains ≥7.9 mm. If the endometrium is too thin, the live birth rate will be reduced.
[1] Mumusoglu S,Polat M,Ozbek IY,et al.Preparation of the endometrium for frozen embryo transfer:a systematic review[J].Front Endocrinol(Lausanne),2021,12:688237.
[2] Pra?nikar E,Kunej T,Knez J,et al.Determining the molecular background of endometrial receptivity in adenomyosis[J].Biomolecules,2020,10:1311.
[3] Puente JM,Fabris A,Patel J,et al.Adenomyosis in infertile women:prevalence and the role of 3D ultrasound as a marker of severity of the disease[J].Reprod Biol Endocrinol,2016,14:60.
[4] Abu Hashim H,Elaraby S,Fouda AA,et al.The prevalence of adenomyosis in an infertile population:a cross-sectional study[J/OL].Reprod Biomed Online,2020,40:842-850.
[5] Halvorson LM,Giudice LC,Stewart EA.Eye to the future in adenomyosis research[J].Semin Reprod Med,2020,38:197-200.
[6] Horton J,Sterrenburg M,Lane S,et al.Reproductive,obstetric,and perinatal outcomes of women with adenomyosis and endometriosis:a systematic review and meta-analysis[J].Hum Reprod Update,2019,25:592-632.
[7] Zhang J,Hu L,Bu Z,et al.Impact of uterine adenomyosis on pregnancy outcomes in women undergoing in vitro fertilization treated with a long-term pituitary downregulation protocol[J].Front Endocrinol(Lausanne),2021,12:655803.
[8] Groenewoud ER,Cohlen BJ,Al-Oraiby A,et al.Influence of endometrial thickness on pregnancy rates in modified natural cycle frozen-thawed embryo transfer[J].Acta Obstet Gynecol Scand,2018,97:808-815.
[9] Farren J,Jalmbrant M,Falconieri N,et al.Posttraumatic stress,anxiety and depression following miscarriage and ectopic pregnancy:a multicenter,prospective,cohort study[J].Am J Obstet Gynecol,2020,222:367.e1-e22.
[10] Nguyen BT,Chang EJ,Bendikson KA.Advanced paternal age and the risk of spontaneous abortion:an analysis of the combined 2011-2013 and 2013-2015 National Survey of Family Growth[J].Am J Obstet Gynecol,2019,221:476.e1-e7.
[11] Vlahos NF,Theodoridis TD,Partsinevelos GA.Myomas and adenomyosis:impact on reproductive outcome[J].Biomed Res Int,2017,2017:5926470.
[12] Khan KN,Fujishita A,Mori T.Pathogenesis of human adenomyosis:current understanding and its association with infertility[J].J Clin Med,2022,11:4057.
[13] Xiang Y,Sun Y,Yang B,et al.Transcriptome sequencing of adenomyosis eutopic endometrium:a new insight into its pathophysiology[J].J Cell Mol Med,2019,23:8381-8391.
[14] Zhang T,Li Z,Ren X,et al.Endometrial thickness as a predictor of the reproductive outcomes in fresh and frozen embryo transfer cycles:A retrospective cohort study of 1512 IVF cycles with morphologically good-quality blastocyst[J].Medicine(Baltimore),2018,97:e9689.
[15] Vaegter KK,Lakic TG,Olovsson M,et al.Which factors are most predictive for live birth after in vitro fertilization and intracytoplasmic sperm injection(IVF/ICSI) treatments?Analysis of 100 prospectively recorded variables in 8,400 IVF/ICSI single-embryo transfers[J].Fertil Steril,2017,107:641-648.e2.
[16] Ribeiro VC,Santos-Ribeiro S,De Munck N,et al.Should we continue to measure endometrial thickness in modern-day medicine?The effect on live birth rates and birth weight[J/OL].Reprod Biomed Online,2018,36:416-426.
[17] Liu KE,Hartman M,Hartman A,et al.The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes:an analysis of over 40 000 embryo transfers[J].Hum Reprod,2018,33:1883-1888.
[18] Kasius A,Smit JG,Torrance HL,et al.Endometrial thickness and pregnancy rates after IVF:a systematic review and meta-analysis[J].Hum Reprod Update,2014,20:530-541.
[19] Shaodi Z,Qiuyuan L,Yisha Y,et al.The effect of endometrial thickness on pregnancy outcomes of frozen-thawed embryo transfer cycles which underwent hormone replacement therapy[J/OL].PLoS One,2020,15:e0239120.
基本信息:
中图分类号:R714.8
引用信息:
[1]徐洁,刘晓娟,蔡贺,等.子宫内膜厚度对子宫腺肌病患者IVF/ICSI胚胎移植后妊娠结局的影响[J].生殖医学杂志,2023,32(10):1477-1484.
基金信息:
陕西省妇科疾病临床研究中心(临床类研究课题)
2023-02-20
2023
2023-09-08
2023
2023-04-26
1
2023-10-15
2023-10-15