取卵前后子宫内膜及内膜下血流情况对单囊胚移植妊娠结局的影响

Influence of endometrial-subendometrial blood flow before and after oocyte pick-up on pregnancy outcome in single blastocyst transfer cycles

目的探讨体外助孕过程中促排卵周期HCG日、取卵后第2天(D2)及取卵后第4天(D4)子宫内膜及内膜下血流情况变化,并探讨其与单囊胚移植周期妊娠结局的关系。方法选取251例行IVF或ICSI助孕并接受单囊胚移植、且HCG日内膜形态为A型的患者,采用经阴彩色多普勒超声成像技术检测HCG注射日、取卵后第2天(D2)及取卵后第4天(D4)子宫内膜厚度、宫腔容积、子宫内膜及内膜下血流情况,并根据血流灌注情况将其分为I、Ⅱ、Ⅲ型。比较HCG注射日、取卵后D2及D4子宫内膜及内膜下血流变化,及其与妊娠结局的关系。结果 HCG日、取卵后D2及D4子宫内膜厚度、宫腔容积均无明显差异(P>0.05);与HCG日相比,取卵后D2及D4子宫内膜及内膜下血流为Ⅱ、Ⅲ型的周期明显减少(P<0.05),取卵后D2与D4之间无明显差异(P>0.05)。HCG日子宫内膜及内膜下血流Ⅰ型组与Ⅱ、Ⅲ型组相比,临床妊娠率降低但无统计学差异(P>0.05),早期流产率明显升高(P<0.05);取卵后D2、D4子宫内膜及内膜下血流Ⅰ型组与Ⅱ、Ⅲ型组相比,临床妊娠率无显著性差异(P>0.05),取卵后D2及D4内膜血流Ⅲ型组无早期流产发生,内膜血流Ⅰ型组早期流产率高于Ⅱ型组,但无统计学差异(P>0.05)。HCG日、取卵后D2内膜血流均为Ⅰ型的周期,其早期流产率明显高于均为Ⅱ、Ⅲ型的周期(P<0.05),内膜血流从HCG日Ⅱ、Ⅲ型变为取卵后Ⅰ型的周期早期流产率高于HCG日、取卵后D2内膜血流均为Ⅱ、Ⅲ型的周期,但无统计学差异(P>0.05)。结论促排卵周期,取卵后子宫内膜及内膜下血流灌注情况明显变差,取卵前后子宫内膜及内膜下血流灌注不足可能增加早期流产率;若取卵周期子宫内膜及内膜下血流灌注不足,可考虑全胚冷冻。

Objective：To investigate the variation of endometrial-subendometrial blood flow on the day of HCG injection and on the day 2（D2）and day 4（D4）after oocyte pick-up（OPU）in IVF cycles,and explore the relationship between this variation and pregnancy outcome in single blastocyst transfer cycles.Methods：A total of 251 women undergoing IVF/ICSI-ET with single blastocyst transfer were included in the study.Their endometrial morphology pattern was type A on the day of HCG injection.Transvaginal color doppler sonography（TV-CDS） was used to monitor the endometrial thickness,uterine volume,and endometrial-subendometrial blood flow on the HCG day,D2 D4 after OPU.According to the endometrial-subendometrial blood flow,the patients were divided into three groups：typeⅠ,typeⅡ and type Ⅲ group.The variation of endometrial-subendometrial blood flow on HCG day and D2 D4 after OPU,and pregnancy outcome were compared among the groups.Results：There were no differences in the endometrial thickness and uterine volume on HCG day,D2 and D4 after OPU（P〈0.05）.The type Ⅱ and type Ⅲ of endometrial-subendometrial blood flow was significantly decreased on D2 and D4 after OPU compared with HCG day（P〈0.05）,but there was no significant difference between D2 and D4（P〈0.05）.The pregnancy rate was not significantly declined（P〈0.05）,but the miscarriage rate was significantly higher in the cycles with typeⅠ blood flow compared with typeⅡ and typeⅢ on HCG day（P〈0.05）.The pregnancy rate had no difference in the cycles of typeⅠblood flow compared with typeⅡ and type Ⅲ on D2 and D4 after OPU（P〈0.05）.There was no early miscarriage in typeⅢ group,and miscarriage rate in typeⅠ group was higher than that in typeⅡ group,but it was not significant（P〉0.05）.The miscarriage rate in the type Ⅰ group was significantly higher than typeⅡ Ⅲ both on HCG day and D2 after OPU（P〈0.05）.The miscarriage rate in the cycles in which the blood flow was from typeⅠ on HCG day changed to typeⅡ Ⅲ on D2 after OPU was higher than in the typeⅡ Ⅲ both on HCG day and D2 after OPU,but no significance（P〉0.05）.Conclusions：In the cycles of controlled ovarian hyperstimulation,if the endometrial-subendometrial blood flow was significantly decreased after OPU,it would result in higher miscarriage rate.Then,the frozen-thawed blastocyst transfer should be considered.