生殖医学杂志

目的探讨体外助孕过程中促排卵周期HCG日、取卵后第2天(D2)及取卵后第4天(D4)子宫内膜及内膜下血流情况变化,并探讨其与单囊胚移植周期妊娠结局的关系。方法选取251例行IVF或ICSI助孕并接受单囊胚移植、且HCG日内膜形态为A型的患者,采用经阴彩色多普勒超声成像技术检测HCG注射日、取卵后第2天(D2)及取卵后第4天(D4)子宫内膜厚度、宫腔容积、子宫内膜及内膜下血流情况,并根据血流灌注情况将其分为I、Ⅱ、Ⅲ型。比较HCG注射日、取卵后D2及D4子宫内膜及内膜下血流变化,及其与妊娠结局的关系。结果 HCG日、取卵后D2及D4子宫内膜厚度、宫腔容积均无明显差异(P>0.05);与HCG日相比,取卵后D2及D4子宫内膜及内膜下血流为Ⅱ、Ⅲ型的周期明显减少(P<0.05),取卵后D2与D4之间无明显差异(P>0.05)。HCG日子宫内膜及内膜下血流Ⅰ型组与Ⅱ、Ⅲ型组相比,临床妊娠率降低但无统计学差异(P>0.05),早期流产率明显升高(P<0.05);取卵后D2、D4子宫内膜及内膜下血流Ⅰ型组与Ⅱ、Ⅲ型组相比,临床妊娠率无显著性差异(P>0.05),取卵后D2及D4内膜血流Ⅲ型组无早期流产发生,内膜血流Ⅰ型组早期流产率高于Ⅱ型组,但无统计学差异(P>0.05)。HCG日、取卵后D2内膜血流均为Ⅰ型的周期,其早期流产率明显高于均为Ⅱ、Ⅲ型的周期(P<0.05),内膜血流从HCG日Ⅱ、Ⅲ型变为取卵后Ⅰ型的周期早期流产率高于HCG日、取卵后D2内膜血流均为Ⅱ、Ⅲ型的周期,但无统计学差异(P>0.05)。结论促排卵周期,取卵后子宫内膜及内膜下血流灌注情况明显变差,取卵前后子宫内膜及内膜下血流灌注不足可能增加早期流产率;若取卵周期子宫内膜及内膜下血流灌注不足,可考虑全胚冷冻。

Objective:To investigate the variation of endometrial-subendometrial blood flow on the day of HCG injection and on the day 2(D2)and day 4(D4)after oocyte pick-up(OPU)in IVF cycles,and explore the relationship between this variation and pregnancy outcome in single blastocyst transfer cycles.Methods:A total of 251 women undergoing IVF/ICSI-ET with single blastocyst transfer were included in the study.Their endometrial morphology pattern was type A on the day of HCG injection.Transvaginal color doppler sonography(TV-CDS) was used to monitor the endometrial thickness,uterine volume,and endometrial-subendometrial blood flow on the HCG day,D2 & D4 after OPU.According to the endometrial-subendometrial blood flow,the patients were divided into three groups:typeⅠ,typeⅡ and type Ⅲ group.The variation of endometrial-subendometrial blood flow on HCG day and D2 & D4 after OPU,and pregnancy outcome were compared among the groups.Results:There were no differences in the endometrial thickness and uterine volume on HCG day,D2 and D4 after OPU(P>0.05).The type Ⅱ and type Ⅲ of endometrial-subendometrial blood flow was significantly decreased on D2 and D4 after OPU compared with HCG day(P<0.05),but there was no significant difference between D2 and D4(P>0.05).The pregnancy rate was not significantly declined(P>0.05),but the miscarriage rate was significantly higher in the cycles with typeⅠ blood flow compared with typeⅡ and typeⅢ on HCG day(P<0.05).The pregnancy rate had no difference in the cycles of typeⅠblood flow compared with typeⅡ and type Ⅲ on D2 and D4 after OPU(P>0.05).There was no early miscarriage in typeⅢ group,and miscarriage rate in typeⅠ group was higher than that in typeⅡ group,but it was not significant(P>0.05).The miscarriage rate in the type Ⅰ group was significantly higher than typeⅡ & Ⅲ both on HCG day and D2 after OPU(P<0.05).The miscarriage rate in the cycles in which the blood flow was from typeⅠ on HCG day changed to typeⅡ & Ⅲ on D2 after OPU was higher than in the typeⅡ & Ⅲ both on HCG day and D2 after OPU,but no significance(P>0.05).Conclusions:In the cycles of controlled ovarian hyperstimulation,if the endometrial-subendometrial blood flow was significantly decreased after OPU,it would result in higher miscarriage rate.Then,the frozen-thawed blastocyst transfer should be considered.