肌壁间子宫肌瘤及子宫动脉血流参数对IVF/ICSI-ET患者临床妊娠及围生期结局的影响

Effect of intramural fibroid and uterine artery blood flow parameters on the pregnancy and perinatal outcome of IVF/ICSI patients

目的探讨经阴道三维超声和宫腔镜检查诊断的未改变宫腔形态子宫肌壁间肌瘤助孕患者肌壁间肌瘤及子宫动脉血流参数对体外授精/单精子卵细胞浆内注射-胚胎移植(IVF/ICSI-ET)临床妊娠及围生期结局的影响。方法采用回顾性队列研究,选取2012年1月至2013年12月在郑州大学第三附属医院生殖医学中心超声及宫腔镜检查显示未改变宫腔形态的单发或多发肌壁间子宫肌瘤180例患者作为研究组;并采用随机数字法抽取180例年龄匹配但未合并子宫肌瘤患者作为对照组。比较两组的一般基线资料、人绒毛膜促性腺激素(h CG)日子宫动脉血流参数、临床妊娠结局及围生期结局等相关指标;采用logistic回归分析影响活产率的相关因素。结果两组h CG日子宫动脉搏动指数(pulsat ile i ndex,PI)、子宫动脉收缩期最高血流速度/舒张期最低血流速度(S/D)、着床率、活产率比较,差异有统计学意义(P<0.05),临床妊娠结局及围生期结局等指标比较,差异均无统计学意义(P>0.05)。logistic回归分析显示,年龄(OR=0.849,95%CI:0.796~0.906,P<0.001)、有无肌瘤(OR=0.532,95%CI:1.196~5.359,P<0.05)、子宫动脉PI、S/D(OR=1.3 46,95%CI:0.205~0.586,P<0.001;OR=1.371,95%CI:1.184~1.588;P<0.001)、h CG日内膜厚度(OR=1.732,95%CI:0.639~0.839,P<0.001)是影响IVF/ICSI助孕患者活产率的独立因素;年龄、子宫动脉S/D、h CG日内膜厚度是影响合并肌壁间肌瘤的IVF/ICSI助孕患者活产率的独立因素(OR=0.876,95%CI:0.790~0.970,P<0.05;OR=2.265,95%CI:1.663~3.087,P<0.001;OR=1.751,95%CI:0.595~0.947,P<0.05)。结论 h CG日子宫动脉血流参数及子宫内膜厚度是影响IVF/ICSI助孕患者活产率的独立因素,肌壁间肌瘤对IVF/ICSI助孕有不利影响。

Objective To investigate the effect of intramural fibroid and hCG day uterine artery blood flow parameters on the pregnancy and perinatal outcomes of in vitro fertilization/Intracytoplasmic sperm injection-embryo transfer patients, who had no significant changes in the morphology of the uterine cavity （diagnosed by transvaginal three-dimensional ultrasonography and hysteroscopy） . Methods A retrospective cohort study was performed in the Third Affiliated Hospital of Zhengzhou University Reproductive Medical Center from January 2012 to December 2013. 180 patients were chosen as research group due to infertility associated with single or multiple intramural myoma and with no significant changes of the -uterine cavity morphology. 180 patients with the similar age and without myoma during the same period were randomly chosen as the control group. The baseline datas, the uterine artery blood flow on the hCG day, the pregnancy and perinatal outcome of the two groups were compared. Logistic regression was used to analyze the related factors of the live birth rate. Results There were statistical differences in the uterine artery pulsatility index, uterine artery S/D on hCG day, implantation rate and live birth rate （P〈0.05） between the two grouPs, No statistical difference in other indexs. Logistic multiple regression analysis showed that, the age （OR = 0.849,95% CI：0.796 -0.906, P〈0.001）, leiomyoma number （OR = 0.532, 95% CI： 1.196-5.359, P〈0.05）, PI of the uterine artery （OR = 1.346, 95% CI：0.205-0.586, P〈0.001） , S/D of uterine artery （OR=1.371, 95% CI： 1.184- 1.588; P〈0.001 ） and the endometrial thickness on hCG day （OR = 1.732, 95% CI： 0.639-0.839） are independent factors of live birth rate of IVF patients. The independent factors influenced live birth rate of IVF patients with intramural myoma were age （OR = 0.876, 95% CI： 0.790 -0.970, P〈0.05） , S/D of uterine artery （OR = 2.265, 95% CI： 1.663 - 3.087, P〈0.001） , the endometrial thickness on hCG day （OR = 1.751,95% CI： 0.595-0.947,P〈0.05） . Conclusion The independent factors influenced live birth rate of IVF patients were uterine artery blood flow parameters and the endometrial thickness on hCG day. Intramural fibroids had adverse effects on IVF assisted pregnancy, but the diameter of fibroids could not be used to predict the live birth rate.