IVF／ICSI-ET中三维超声对子宫内膜容受性的评价价值

Role of three-dimensional ultrasound in evaluating endometrial receptivity during IVF/ICSI-ET treatment

目的:探讨三维超声在体外受精/卵胞质内单精子显微注射-胚胎移植(IVF/ICSI-ET)中对子宫内膜容受性的评价价值。方法:回顾性分析422例IVF/ICSI助孕患者h CG注射日子宫内膜三维超声参数,将妊娠组与非妊娠组资料进行比较,并进一步根据年龄(<35岁,≥35岁)、内膜体积(<2.5 ml,≥2.5 ml)分层,分析各项超声参数与妊娠结局的关系。结果:妊娠组234例,非妊娠组188例,妊娠组年龄、不孕年限显著低于非妊娠组(P<0.05),内膜体积显著大于非妊娠组(P<0.05),Logistic回归显示年龄及内膜体积对妊娠有预测价值。年龄<35岁时,妊娠组与非妊娠组患者一般资料及各项超声参数均无统计学差异(P>0.05);年龄≥35岁时,妊娠组内膜体积显著大于非妊娠组(P<0.05),一般资料及其它超声参数无统计学差异(P>0.05)。与内膜体积<2.5 ml组相比,内膜体积≥2.5 ml组临床妊娠率及胚胎种植率均显著增加(P<0.05);患者体质量指数(BMI)显著降低(P<0.05),内膜厚度及内膜螺旋动脉血流参数收缩期峰值血流速度(PSV)、舒张期峰值血流速度(EDV)、搏动指数(PI)、阻力指数(RI)、血流指数(FI)均显著增加(P<0.05)。结论:IVF/ICSIET中子宫内膜h CG注射日三维超声测定对内膜容受性的评价具有一定作用,内膜体积对妊娠有预测作用,高龄患者可根据h CG注射日内膜体积慎重选择ET时机,提高妊娠率,避免有限的优质胚胎浪费。

Objective： To explore the value of endometrial parameters by three-dimensional ultrasonogra- phy and power Doppler angiography （3D US-PDA） in assessing endometrial receptivity during in vitro fertilization/ intracytoplasmic sperm injection-embryo transfer （IVF/ICSI-ET）. Methods： Three-dimensional ultrasound parameters of 422 women measures on hCG injection day were retrospectively analyzed. These variables in pregnant and non-pregnant patients were compared. Stratified analysis was carried out according to age （〈35 years old, 〉i 35 years old） and endometrial volume （〈2.5 ml, 〉~ 2.5 ml）, respectively. Results： There were 234 women in pregnant group and 188 in non-pregnant group. Compared with the non-pregnant group, the pregnant group exhibited significantly lower age, infertility duration, and significantly higher endometrial volume, while the two groups did not significantly differ in demographic data and other ultrasound parameters. In patients 〈35 years old, there was no significant difference of patient general condition or endometrial ultrasound parameters between pregnant and non-pregnant groups, while significantly higher endometrial volume was exhibited in pregnant group when patients ≥ 35 years old. Compared with patients with endometrial volume 〈2.5 ml, those with endometrial volume ≥ 2.5 ml exhibited significantly higher clinical pregnancy rate and implantation rate, and significantly higher endometrial thickness, endometrial spiral arteries peak systolic velocity （PSV）, end diastolic velocity （EDV）, pulsatility index （PI）, resistance index （RI）, flow index （FI）, while significantly lower body mass index （BMI） at the same time. Couclution： In IVF/ICSI-ET cycles, three-dimensional ultrasound measurement on hCG injection day is useful for evaluating endometrial receptivity. Endometrial volume favours pregnancy, according to which aged women can make decision on ET to improve chance of pregnancy, and avoid wasting limited good-quality embryos.