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目的分析薄型内膜患者冻融胚胎移植(FET)周期的临床结局及相关影响因素。方法回顾性分析2018年1月至2019年5月在安徽医科大学第一附属医院妇产科生殖中心行激素替代FET治疗的191例薄型子宫内膜患者(薄型组)的临床资料。选择同期在本中心行激素替代周期FET且内膜转化日内膜厚度>8 mm的115例患者作为非薄型组。根据是否获得临床妊娠将薄型组分为妊娠组(60例)和非妊娠组(131例)两个亚组;根据不同的内膜厚度将薄型组分为En<6 mm组(9例)、6 mm≤En<7 mm组(46例)和7 mm≤En<8 mm组(136例)3个亚组。比较各组患者的一般资料及妊娠结局;采用Logistic回归模型分析薄型组妊娠结局的相关影响因素。结果薄型组患者继发性不孕症占比、既往妊娠次数、宫腔操作史比例、流产率显著高于非薄型组(P<0.05),而胚胎种植率、临床妊娠率、活产率、新生儿出生体重则显著低于非薄型组(P<0.05);两组的年龄、不孕年限、体质指数(BMI)、移植胚胎数、分娩孕周比较均无显著性差异(P>0.05)。薄型组中妊娠组年龄、不孕年限、原发性不孕症患者占比、中重度宫腔粘连发生率均显著低于非妊娠组(P<0.05);7 mm≤En<8 mm组的临床妊娠率(32.35%)较6 mm≤En<7 mm组(30.43%)及En<6 mm组(22.22%)有增长趋势,但尚无显著性差异(P>0.05)。二元Logistic回归分析显示,患者年龄(OR=0.924,P=0.019)、是否中重度宫腔粘连(OR=3.188,P=0.012)、不孕类型(OR=0.292,P=0.045)为薄型内膜患者不同妊娠结局的独立影响因素。女方年龄增加、中重度宫腔粘连、合并原发性不孕是薄型内膜患者妊娠结局的不利因素。结论薄型子宫内膜降低了FET周期的临床妊娠率、活产率及新生儿出生体重,但对分娩孕周无显著影响。相较于原发性不孕合并薄型子宫内膜者,继发性不孕合并薄型子宫内膜者临床妊娠率较高;女方年龄增加、中重度宫腔粘连史是薄型内膜患者妊娠结局的不利因素。
Abstract：Objective:To analyze the clinical outcome and related influencing factors of frozen-thawed transfer(FET) in the patients with thin endometrium.Methods:The clinical data of 191 patients with thin endometrium(thin endometrium group),who underwent hormone replacement treatment(HRT) & FET in Reproductive Medicine Center,Department of Obstetrics and Gynecology,the First Affiliated Hospital of Anhui Medical University were analyzed retrospectively. The clinical data of 115 patients who had endometrium >8 mm on endometrial transformation day and underwent HRT & FET during the same period were selected as the non thin endometrium group. According to whether there was clinical pregnancy was obtained,the thin endometrium group was subdivided into pregnancy group(n=60) and non clinical pregnancy group(n=131). According to the endometrial thickness,the thin endometrium group was divided into three subgroups:En<6 mm group(n=9),6 mm≤En<7 mm group(n=46) and 7 mm≤En<8 mm group(n=136). The general data and pregnancy outcomes of patients in each group were compared. Logistic regression model was used to analyze the related influencing factors of pregnancy outcomes in the thin group.Results:The proportion of secondary infertility,the previous gravidity,the history of uterine cavity operation and the abortion incidence in the thin endometrium group were significantly higher than those in non thin endometrium group(P<0.05),but the embryo implantation rate,the clinical pregnancy rate,the rate of live birth rate and the birth weight of newborn were significantly lower than those in non thin endometrium group(P<0.05). There were no significant differences in age,infertility years,the proportion of primary infertility,body mass index(BMI),number of embryos transferred and gestational week between the two groups(P>0.05). In the thin endometrium group,the age,infertility duration,proportion of primary infertility,incidence of moderate and severe intrauterine adhesions in the clinical pregnancy group were significantly lower than those in the non clinical pregnancy group(P<0.05). The clinical pregnancy rate of 7 mm≤EN<8 mm group(32.35%)was higher than that of 6 mm≤EN<7 mm group(30.43%) and EN<6 mm group(22.22%),but there was no significant difference(P>0.05). Binary logistic regression analysis showed that age(OR=0.924,P=0.019),moderate or severe intrauterine adhesion(OR=3.188,P=0.012),infertility type(OR=0.292,P=0.045) were independent factors affecting the pregnancy outcomes in patients with thin endometrium. The woman'age increasing,moderate and severe intrauterine adhesion,and primary infertility are the adverse factors of pregnancy outcome in the patients with thin type endometrium.Conclusions:Thin endometrium reduces the clinical pregnancy rate,live birth rate and newborn weight in the frozen-thawed cycle,but there is no significant effect on the gestational period. The clinical pregnancy rate of the secondary infertility patients is higher than that of the primary infertility patients with thin endometrium. The women'age increasing,the history of moderate and severe intrauterine adhesion are the adverse factors of pregnancy outcome in the patients with thin type endometrium.
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基本信息:
中图分类号:R714.8
引用信息:
[1]韩丹,吴欢,曹云霞,等.薄型子宫内膜患者冻融胚胎移植周期妊娠结局及影响因素分析[J].生殖医学杂志,2020,29(08):1049-1054.
2020-08-15
2020-08-15