冻融胚胎移植周期中子宫内膜厚度与妊娠结局的关系

Relationship between endometrial thickness and pregnancy outcomes based on frozen-thawed embryo transfer cycles

目的探讨冻融胚胎移植周期中子宫内膜厚度与妊娠结局的关系。方法回顾性分析2014年1月至2015年12月北京大学人民医院1475例冻融胚胎移植周期患者的临床资料,按照自然月经患者排卵日、激素替代人工周期患者子宫内膜转化日的子宫内膜厚度(4~16mm)纳入研究,对不同子宫内膜厚度患者以及薄型子宫内膜(内膜厚度≤6mm)患者的妊娠结局进行统计学分析,评估指标包括临床妊娠率、胚胎种植率、流产率、多胎率、活产率。结果共纳入1475个冻融胚胎移植周期,患者的年龄为(32.5±3.9)岁,平均子宫内膜厚度为(9.2±1.9)mm,平均移植胚胎数为(2.03±0.37)个;其中,自然周期518个(35.1%),人工周期957个(64.9%);移植卵裂期胚胎700个周期(47.5%),移植囊胚775个周期(52.5%);总体临床妊娠率、胚胎种植率、流产率、多胎率、活产率分别为54.4%、35.7%、23.3%、24.1%、43.9%,异位妊娠发生率为0.6%。分析薄型子宫内膜患者显示,妊娠者的双原核胚胎数量及可利用胚胎数均明显多于非妊娠者(P=0.016、P=0.024),加用西地那非或生长激素并未改善薄型子宫内膜患者的妊娠结局(P=0.183、P=0.400);在薄型子宫内膜患者中,移植妊裂期胚胎与囊胚患者的临床妊娠率、胚胎种植率及活产率无差异(P均>0.05)。结论薄型子宫内膜患者的妊娠结局不良,薄型子宫内膜患者卵裂期胚胎与囊胚移植的临床妊娠率、胚胎种植率、活产率基本一致;与卵裂期胚胎相比,囊胚在薄型子宫内膜患者中较非薄型子宫内膜患者其临床妊娠率下降更显著;提高胚胎质量,可改善薄型子宫内膜患者的妊娠结局;加用西地那非、生长激素不能改善薄型子宫内膜患者的妊娠结局。

Objective To explore the relationship between endometrial thickness and clinical pregnancy outcomes in frozen-thawed embryo transfer cycles. Methods A prospective study was performed for 1 475 frozen-thawed embryo transfer cycles at Peking University People′s Hospital from January 2014 to December 2015. The patients were divided into different groups according to endometrial thickness of ovulation day in natural menstrual cycles or endometrial transformation day in hormone replacement cycles;patients with thin endometrium were enndometrial thickness≤6 mm. Then the clinical pregnancy outcomes including clinical pregnancy rate, embryo implantation rate, abortion rate, multiple birth rate and live birth rate were analyzed. Results In all, 1 475 frozen-thawed embryo transfer cycles were analyzed. The mean age of patients was(32.5 ± 3.9)years old and mean endometrial thickness was(9.2 ± 1.9)mm, and mean number of embryos was 2.03 ± 0.37. The study included 518(35.1%)natural menstrual cycles and 957 (64.9%)hormone replacement cycles. The number of embryo-transfer cycles and blastocyst-transfer cycles were respectively 700(47.5%)and 775(52.5%). The overall clinical pregnancy rate, embryo implantation rate, abortion rate, multiple birth rate and live birth rate were 54.4%, 35.7%, 23.3%, 24.1%, 43.9%, respectively. The ectopic pregnancy rate in the study was 0.6%. In patients with thin endometrium, there were significant differences in 2 pronucleus count (P=0.016) and available embryo count (P=0.024) between cycles that resulted in pregnancy and those that did not; besides, the use of sildenafil and growth hormone did not improve pregnancy outcomes in patients with thin endometrium(P=0.183, P=0.400). The clinical pregnancy rate, embryo implantation rate and live birth rate of embryo-transfer and blastocyst-transfer were similar in patients with thin endometrium(all P>0.05). Conclusions Patients with thin endometrium have poor pregnancy outcomes. The clinical pregnancy rate, embryo implantation rate and live birth rate of embryo-transfer and blastocyst-transfer are similar in patients with thin endometrium. Compared thin endometrium and non-thin endometrium patients, the clinical pregnancy rate and live birth rate of blastocysts have more substantial decline than those of embryos. Improving the quality of embryo could improve the pregnancy outcome of patients with thin endometrium. Sildenafil and growth hormone could not improve pregnancy outcome in patients with thin endometrium.