近排卵期高回声子宫内膜及干预对子宫内膜异位症患者体外受精结局的影响

Influence of endometrial dense-echoes in preovulatory phase and interventions to them on the outcomes of in vitro fertilization in infertile women with endometriosis

目的:评价近排卵期高回声子宫内膜及干预对子宫内膜异位症(内异症)患者体外受精(IVF)结局的影响。方法:内异症性不孕患者142例(147个周期),IVF前阴道B超监测自然周期子宫内膜,以近排卵期出现高回声子宫内膜患者为研究组,根据是否干预内膜再分成干预组(39例,42个周期)和未干预组(19例,19个周期);以内膜形态正常患者为对照组(84例,86个周期)。分析3组IVF结局。结果:干预组种植率及临床妊娠率高于未干预组及对照组(P<0.05);未干预组种植率低于对照组(P<0.05),临床妊娠率低于对照组(分别为15.8%及36.0%),但差异无统计学意义;干预组与未干预相比,HCG日内膜异常形态比率显著降低(P<0.05);干预组与对照组相比,HCG日内膜异常比率高,A型内膜比率低,B型内膜比率显著升高(P<0.05);未干预组与对照组相比,HCG日异常内膜比率高,A型及B型内膜比率低(P<0.05)。结论:内异症患者自然周期近排卵期出现高回声子宫内膜可降低IVF种植率及临床妊娠率,干预后可改善内膜形态及IVF结局。

Objective：To evaluate influence of endometrial dense-echoes in preovulatory phase and intervention to them on the outcomes of in vitro fertilization （IVF） in infertile women with endometriosis. Methods： There were 142 infertile women with endometriosis who had 147 IVF cycles,transvaginal sonography was performed in follicular phase in natural period before IVF. In test groups there were 58 patients who were found endometrial dense-echoes in preovulatory phase,according to intervention to endometrium, they were subdivided into intervention group （39 patients,42cycles） and nonintervention group （ 19 patients, 19 cycles）. 84 patients （86 cycles） in control group who had normal endometrial echoes. The results of the outcomes of IVF were analysed among three groups. Results ： The implantation rate and clinic pregnancy rate in intervention group were statistically higher than that in nonintervention group and control group （ P〈 0.05 ）. The implantation rate in nonintervention group was statistically lower than that in control group （ P 〈 0.05 ）, the clinic pregnancy rate in nonintervention group was lower than that in control group （15.8% and 36.0% , respectively） , but there was no statistical significance （P〉0.05）. The rate of abnormal endometrial echoes in date of HCG in intervention group were statistically lower than that in nonintervention group （P 〈 0.05 ） ;The rate of type A was significantly higher in intervention group compared with control,while the rate of type B was significantly lower. Compared with control group , the rates of type A and B were both significantly higher. Conclusion：In infertile women with endometriosis, endometrial denseechoes in preovulatory phase can reduce implantation rate and clinic pregnancy rate,and inter- vention to them can improve the sonographic appearance of endometrium and the outcomes of IVF.