子宫内膜增生症病史对不孕症患者IVF/ICSI-ET助孕结局的影响

Effects of endometrial hyperplasia history on IVF/ICSI-ET pregnancy outcomes in patients who are infertile

目的探讨子宫内膜增生症药物治疗是否影响体外受精/卵胞质内单精子注射-胚胎移植(IVF/ICSI-ET)助孕的妊娠结局。方法采用回顾性队列研究,选择于我中心行IVF/ICSI-ET助孕且既往有子宫内膜增生症治疗史的患者为研究组(n=85)。按照年龄匹配,因单纯输卵管因素不孕行IVF/ICSI助孕的患者为对照组(n=145)。比较2组间的一般情况及妊娠结局。结果与对照组比较,研究组患者不孕时间长、原发不孕比例高、体质量指数(BMI)高(均P<0.05),余基础数据差异无统计学意义(均P>0.05)。二元logistic回归提示BMI是子宫内膜病变的独立危险因素(OR=1.295,95%CI:1.139~1.473,P<0.01)。按照BMI对2组患者进行分层比较,超重及肥胖人群中有子宫内膜增生症病史的患者子宫内膜厚度较对照组薄(P<0.05)。但每层患者2组间的生化流产率、临床妊娠率、早期流产率、晚期流产率、每周期活产率及新生儿出生体质量均无统计学差异(均P>0.05)。将研究组患者再分为子宫内膜增生不伴不典型增生(EH)组和子宫内膜不典型增生(AH)组进行比较,AH组的子宫内膜厚度薄于EH组(P<0.05),但2组生育结局比较无统计学差异(均P>0.05)。结论有子宫内膜增生症病史的不孕症患者行IVF/ICSI助孕,虽然胚胎移植前子宫内膜厚度受到影响,但妊娠结局未受明显影响。

Objective To investigate the effect of endometrial hyperplasia history on pregnancy outcomes of patients who are infertile and underwent IVF/ICSI-ET-assisted pregnancy.Methods A retrospective cohort study was conducted.Patients with a history of endometrial hyperplasia and assisted pregnancy with IVF/ICSI-ET in our center were selected as the study group(n=85).Patients with tubal infertility alone who underwent IVF/ICSI were selected as the control group according to age matching(n=145).The general situation and pregnancy outcome between the two groups were compared.Results The endometrial hyperplasia group had a long infertility time,high proportion of primary infertility,and high body mass index(BMI)(all P<0.05),and no differences were noted in other basic data between the groups(all P>0.05).Binary logistic regression suggested that BMI was an independent risk factor for endometrial lesions(OR=1.295,95%CI:1.139-1.473,P<0.01).Stratified comparison was conducted according to BMI.The intimal thickness of patients who are overweight and obese with endometrial hyperplasia was thinner than that of the normal control group(P<0.05).However,no significant differences were noted in the biochemical abortion rate,clinical pregnancy rate,early abortion rate,late abortion rate,live birth rate per cycle,and newborn birth weight between the two groups of patients(all P>0.05).Patients with endometrial hyperplasia were divided into two subgroups according to pathological types:the endometrial hyperplasia without atypia(EH)and endometrial atypical hyperplasia(AH)groups and were compared.The endometrial thickness of the AH group was thinner than that of the EH group(P<0.05).However,no significant difference was noted in fertility outcome between the groups(all P>0.05).Conclusion IVF/ICSI-assisted pregnancy affected the endometrial thickness in patients who are infertile and with a history of endometrial hyperplasia;however,the pregnancy outcome is not significantly affected.