生殖医学杂志

目的 探讨不孕症患者接受不同宫腔操作对体外受精-胚胎移植(IVF-ET)临床结局的影响。方法 回顾性分析2013年8月至2020年8月于联勤保障部队第九○○医院生殖医学中心首次行胚胎植入前遗传学检测(PGT)助孕治疗的580例不孕症患者的临床资料。根据有无宫腔操作史分为宫腔操作史组(380例)和无宫腔操作组(200例),又根据不同宫腔操作方式将宫腔操作史组分为刮宫组(114例)和宫腔镜组(161例),比较各组患者的一般资料及妊娠结局；并采用多因素Logistic回归分析PGT助孕妊娠结局的影响因素。结果 宫腔操作史组及宫腔镜组的年龄显著高于无宫腔操作组(P<0.05),宫腔操作史组及刮宫组的转化日内膜厚度显著薄于无宫腔操作组(P<0.05),刮宫组的转化日内膜厚度显著薄于宫腔镜组(P<0.05)。宫腔操作史组及宫腔镜组的着床率、临床妊娠率及活产率均显著低于无宫腔操作组(P<0.05),流产率显著高于无宫腔操作组(P<0.05)。刮宫组的流产率显著高于无宫腔操作组(P<0.05),而着床率、临床妊娠率及活产率均与无宫腔操作组无显著性差异(P>0.05)。多因素Logistic回归分析显示，年龄和子宫内膜厚度与PGT助孕妊娠结局无明显相关性(P>0.05),有无宫腔操作史是影响PGT助孕结局的独立影响因素(P<0.05)。结论 宫腔操作史会使子宫内膜厚度变薄，降低IVF-ET成功率。有刮宫史的患者流产率明显升高；有宫腔镜手术史的患者临床妊娠率、活产率明显降低，流产率明显升高。因此，在临床诊疗中应尽量避免不必要的宫腔操作。

Objective:To explore the influence of different intrauterine operations on the clinical outcomes of IVF-ET in infertile patients.Methods:The clinical data of 580 infertile patients who underwent assisted pregnancy treatment and preimplantation genetic testing(PGT) for the first time in the center for reproductive medicine of 900^th hospital from August 2013 to August 2020 were retrospectively analyzed. According to the history of intrauterine operation, they were divided into two groups: intrauterine operation history group(n=380) and non-intrauterine operation history group(n=200). Furthermore, according to different modes of intrauterine operations, the patients in the intrauterine operation history group were subdivided into the curettage group(n=114) and the hysteroscopy group(n=161). Multivariate logistic regression was used to analyze the influencing factors of PGT assisted pregnancy outcome.Results:Compared to non-intrauterine operation history group, the age was significantly elder, and the endometrial thickness was significantly thinner in intrauterine operation history group and hysteroscope group(P<0.05). The endometrial thickness on conversion day of curettage group was significantly thinner than hysteroscope group(P<0.05). The implantation rate, pregnancy rate and live birth rate were significantly lower(P<0.05),and the abortion rate was significantly higher in intrauterine operation history group and hysteroscope group compared with non-intrauterine operation history group(P<0.05). The abortion rate of curettage group was significantly higher than non-intrauterine operation history group(P<0.05),but the implantation rate, clinical pregnancy rate and live birth rate were not significantly different with non-intrauterine operation history group(P>0.05). Multivariate logistic regression analysis showed that age and endometrial thickness had no significant correlation with PGT assisted pregnancy outcome(P>0.05),and the presence or absence of intrauterine operation history was an independent factor affecting PGT assisted pregnancy outcome(P<0.05).Conclusions:Intrauterine operation can lead to thinner endometrial thickness and lower IVF-ET success rate. The curettage history results in a significant increase of abortion rate. The clinical pregnancy rate and live birth rate of the patients with hysteroscope history are significantly reduced, and the abortion rate is increased. Therefore, unnecessary intrauterine operation should be avoided as far as possible.