经阴道彩色多普勒超声对体外受精-胚胎移植子宫内膜容受性的评估价值

Evaluation of endometrial receptivity during in-vitro fertilization using transvaginal color Doppler ultrasonography

目的：探讨子宫内膜厚度、类型及子宫动脉血流动力学状态对体外受精与胚胎移植（IVF-ET）中子宫内膜容受性的预测价值。方法：应用经阴道彩色多普勒超声对131例接受IVF-ET的不孕症患者于控制性超排卵（COH）周期启动日及人绒毛膜促性腺激素（HCG）注射日进行子宫内膜厚度、类型及子宫动脉搏动指数（PI）、阻力指数（RI）检测。结果：131例患者中临床妊娠49例，妊娠率为37．40％。周期启动日子宫内膜厚度为3～8mm，HCG注射日子宫内膜厚度为8～17mm时，随着内膜厚度的增加，妊娠率提高。当周期启动日子宫内膜厚度≥9mm及HCG注射日子宫内膜厚度≤7mm或≥18mm时妊娠率为零。三线型子宫内膜患者妊娠率（46．34％）明显高于均质型（22．45％）（P〈0．05）。周期启动日及HCG注射日妊娠组子宫动脉PI、RI均小于未妊娠组（P〈0．05）。结论：经阴道彩色多普勒超声可通过检测子宫内膜厚度、类型及子宫动脉PI、RI，无创性预测子宫内膜容受性，评估IVF-ET妊娠结局。

Objective To investigate the role of endometrial thickness,pattern and uterine artery blood flow in assessing endometrial receptivity in an in vitro fertilization （IVF） program. Methods One hundred and thirtyone patients undergoing IVF cycles were recruited. Transvaginal color Doppler was performed on the priming day and human chorionic gonadotropin （HCG） injection day to determine endometrial thickness, endometrial pattern, pulsatility index（PI） and resistance index （RI） of uterine artery. Results The pregnancy rate was 37.40% （49/131）. When endometrial thickness on the priming day and HCG injection day was 3～8 mm,8～17 mm,the thicker endometrial thickness was, the higher the pregnancy rate was. Minimum endometrial thickness on HCG injection day associated with pregnancy was 7 mm,maximum endometrial thickness on the priming day and HCG injection day were 9 mm and 18 mm, respectively. In those who had a triple-line pattern on HCG injection day, the pregnancy rate was 46.34% ,and it was 22.45% in those with a homogeneous pattern（ P〈0.05）. Uterine artery PI,RI on the priming day and HCG injection day were significantly lower in the pregnant group than those in the non-pregnant group（ P 〈0.05）. Conclusions Endometrial thickness, pattern and uterine artery PI, RI measured by Doppler ultrasound are good predictors of endometrial receptivity in IVF-ET.