宫腔粘连分离术后患者内膜因素对IVF/ICSI-ET助孕结局的影响分析  

Effect of endometrium factor on IVF/ICSI-ET outcomes in patients after resection of intrauterine adhesion

作　　者：袁纯[1] 钱易[1] 高彦[1] 刁飞扬[1] 马翔[1] 刘嘉茵[1] YUAN Chun;QIAN Yi;GAO Yan;DIAO Fei-yang;MA Xiang;LIU Jia-yin(Reproductive Medicine Center,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029)

机构地区：[1]南京医科大学第一附属医院生殖医学中心,南京210029

出　　处：《生殖医学杂志》2021年第7期885-889,共5页Journal of Reproductive Medicine

基　　金：生殖医学国家重点实验室开放基金课题(SKLRM-K201805);江苏省自然科学青年基金(BK20191076);国家自然科学青年基金(81901449)。

摘　　要：目的探讨宫腔粘连分离术后患者行IVF/ICSI-ET助孕时,其内膜因素、移植方案选择等因素对助孕结局的影响。方法本研究纳入了2017~2018年在本中心接受宫腔镜下粘连分离术后行IVF/ICSI-ET助孕治疗的患者,共123人(265周期)。根据美国生育学会(AFS)分级分为轻度宫腔粘连组(A组)和中重度宫腔粘连(B组)两组,统计两组患者相关病史、胚胎移植方案、子宫内膜厚度及分型、胚胎种植率、临床妊娠率、活产率等数据。结果两组间鲜胚移植周期或冻融胚胎移植(FET)周期HCG阳性率、临床妊娠率以及活产率均无统计学差异(P>0.05)。在FET周期激素替代(HRT)方案中,B组的薄型子宫内膜发生率较A组显著增加(42.11%vs 22.22%,P<0.05),且移植前内膜分型不佳(A/A-B型占比26.32%vs 58.33%,P<0.05);微刺激方案中,B组患者内膜厚度显著低于A组患者[(7.19±2.02)mm vs.(8.78±2.08)mm,P<0.05];自然周期中,B组患者较A组患者薄型子宫内膜发生率显著增加(46.67%vs.8.33%,P<0.05),平均内膜厚度显著降低[(7.47±1.34)mm vs(8.35±1.33)mm,P<0.05)。妊娠结局的统计分析发现,A组患者FET周期各内膜准备方案之间妊娠结局无显著差异(P>0.05);但B组FET周期内膜准备方案亚组中,HRT方案和微刺激方案的HCG阳性率显著高于自然周期方案(50.88%vs.23.33%,66.67%vs.23.33%,P<0.05),且HRT方案活产率显著高于微刺激方案(24.56%vs.6.06%,P<0.05)。结论不同程度的宫腔粘连患者粘连分离术后的鲜胚移植周期及FET周期临床结局均无统计学差异;中重度宫腔粘连患者FET周期中的内膜情况显著差于轻度宫腔粘连患者,HRT内膜准备方案可改善中重度宫腔粘连患者的FET周期妊娠结局。Objective:To explore the effect of endometrial factor and embryo transfer protocol on the pregnancy outcomes of IVF/ICSI-ET in patients after the resection of intrauterine adhesion(IUA).Methods:This study included 123 IVF/ICSI-ET patients(256 cycles)who underwent hysteroscopy resection of IUA in our hospital from 2017 to 2018.The patients were divided into two groups depended on American Fertility Society(AFS)scoring and grading standards:mild IUA group(group A)and moderate-severe IUA group(group B).The history of related disease,embryo transfer protocol,endometrial thickness and classification,embryo implantation rate,clinical pregnancy rate,and live birth rate were compared between the two groups.Results:Whether fresh embryo transfer or frozen-thawed embryo transfer(FET),there was no significant difference in HCG positive rate,clinical pregnancy rate and live birth rate between the two groups(P>0.05).In FET cycles with hormone replacement therapy(HRT)protocol,the incidence of thin endometrium in group B was higher than that in group A(42.11%vs.22.22%,P<0.05),and the ratio of A+A-B type of endometrium was lower(26.32%vs.58.33%,P<0.05).In mild stimulation protocol,the endometrium thickness of group B was significantly thicker than that in group A[(7.19±2.02)mm vs.(8.78±2.08)mm,P<0.05].In natural protocols,the incidence of thin endometrium in group B was significantly higher(46.67%vs 8.33%,P<0.05),and the endometrium thickness was thicker than that in group A[(7.47±1.34)mm vs.(8.35±1.33)mm,P<0.05].There was no significant difference in pregnancy outcome among different endometrial preparation protocols in group A(P>0.05).However,the HCG positive rate of HRT protocol(50.88%vs.23.33%)and mild stimulation protocol(66.67%vs.23.33%)was significantly higher than that of natural cycle(P<0.05),and the live birth rate of HRT protocol was significantly higher than that of mild stimulation protocol in group B(24.56%vs.6.06%,P<0.05).Conclusions:There was no significant difference in the clinical outcomes between fresh emb

关 键 词：宫腔粘连 胚胎移植 子宫内膜 激素替代 妊娠结局 

分 类 号：R711.74[医药卫生—妇产科学] R711.6[医药卫生—临床医学]