经阴道三维超声在冻融胚胎解冻移植时机选择中的运用价值

Role of transvaginal three-dimensional ultrasound in selecting transfer timing of FET cycles

目的评价经阴道三维(3D)彩色多普勒超声测定子宫内膜的形态、厚度、容积、内膜及内膜下血流指数预测子宫内膜容受性对选择冻胚解冻移植(FET)时机的作用。方法对110例行FET的患者移植日子宫内膜的形态、厚度、容积、内膜及内膜下血流分型及血流指数进行经阴道三维超声测定。根据临床妊娠与否分为两组,比较上述指标在两组之间有无差异。结果 110例患者中临床妊娠44例,临床妊娠率为40%,妊娠组与未妊娠组间虽子宫内膜的厚度、容积差异无统计学意义(P>0.05),但子宫内膜容积<2.0ml的4例患者,无一例妊娠。妊娠组与未妊娠组间子宫内膜形态、内膜及内膜下血流分型差异有统计学意义(P<0.05),妊娠组子宫内膜S/D、PI、RI低于未妊娠组,差异有统计学意义(P<0.05)。结论通过阴道三维彩色多普勒超声测定子宫内膜形态、容积、内膜及内膜下血流分型、血流动力学参数可以预测子宫内膜容受性,对临床选择FET移植时机有指导价值。

Objective To evaluate the role of transvaginal three-dimensional（3D）color Doppler ultrasound measurements of endometrial pattern, endometrial thickness, endometrial volume, endometrium and endometrial blood distribution patterns and flow index in predicting endometrial receptivity to help to select timing of freezing embryo transfer（FET）. Methods 110 FET patients ware recruited. Transvaginal three-dimensional color Doppler ultrasound examination was performed to determine endametrial pattern, endometrial thickness, endometrial volume, the blood flow distribution patterns, pulsatility index （ PI）, resistance index （ RI）, systolic/diastolic ratio （ S/D ） of endometrial and subendometrial blood flows on the transplanted day of FET. Based on the clinical pregnancy or not, patients were divided into two groups. The comparison of these indicators were carried out between pregnant group and non pregnant group. Results In the 110 FET cases, the clinical pregnancy was 44 cases, the clinical pregnancy rate was 40%. There were no significant difference（ P 〉 0. 05）between the pregnant group and non-pregnant group in endometrial thickness and endometrial volume. In the endometrial volume subgroup 〈 2 ml, no one was pregnant in 5 patients. The endometrial pattern, endometrial and subendometria blood flows had statistical difference（P 〈 0. 05 ） between the two groups. Patients in the pregnant group had lower PI, RI and S/D of endometrial and subendometrial blood flows than those in the non-pregnant group （ P 〈 0.05 ）. Conclusion Endometrial pattern, endometrium volume, endometrial and subendometria blood flows measured with transvaginal color Doppler ultrasound can be as reliable indicators to assess endometrial receptivity and to guide the time selecting of FET transplantation.