合并子宫内膜息肉不孕症患者息肉切除术后行辅助生殖助孕活产率的影响因素分析

Influencing factors of live birth in infertile women with IVF/ICSI treatment after hysteroscopic polypectomy

目的分析合并子宫内膜息肉不孕症患者经宫腔镜子宫内膜息肉电切术(TCRP)后行体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕治疗活产率的影响因素。方法回顾性分析我中心2015年6月至2016年12月诊断为子宫内膜息肉(EPs)不孕症患者(496例)的临床资料。纳入患者行TCRP术后进一步接受IVF/ICSI助孕治疗,根据最后的活产情况将患者分为两组:无活产组(n=250)和活产组(n=246),比较两组患者之间各项临床指标的差异,应用多元回归模型确定活产率的独立影响因素。结果纳入的496例患者中246例获得活产,总活产率为49.6%。活产组患者的平均年龄、体重指数(BMI)及术后恢复时间均显著小于无活产组(P<0.05)。IVF/ICSI治疗期间,无活产组的子宫内膜厚度显著薄于活产组(P<0.05)。行多元回归分析发现,年龄、BMI、术后恢复时间和HCG日子宫内膜厚度可能为影响TCRP术后活产率的独立因素(P<0.05),且宫腔恢复时间与HCG日子宫内膜厚度呈负相关(P<0.05)。其他相关参数包括息肉的位置和数量、宫腔恢复至胚胎移植间隔时间则与活产率无显著相关(P>0.05)。结论年龄、BMI、术后恢复时间和HCG日子宫内膜厚度可能是影响TCRP术后活产率的独立因素,因此,对于不孕症合并子宫内膜息肉需行手术治疗的患者,临床上应关注患者个体情况包括年龄、BMI等因素进行个体化治疗,以促进术后宫腔恢复,有利于提高下一步IVF/ICSI活产。

Objective : To identify the influencing factors of live birth in infertile women of IVF/ICSI treatment after hysteroscopic polypectomy. Methods : The data of 496 infertile patients who underwent IVF/ICSI treatment after hysteroscopic polypectomy with a loop bipolar electrode were retrospectively analyzed. The patients were divided into two groups:non-live birth group ( n =250) and live birth group ( n =246). The demographic and clinical parameters were compared between the two groups. Multivariate regression model was used to identify independent predictive factors for live birth. Results : In 496 patients,the live birth rate was 49.6%( n =246). The mean age,body mass index (BMI) and postoperative recovery time of the live birth group were significantly lower than those of the non-live birth group ( P <0.05). Multiple regression analysis showed that age,BMI,postoperative recovery time and endometrial thickness on HCG day were the independent factors affecting the live birth rate after hysteroscopic polypectomy ( P <0.05). Moreover,the recovery time of uterine cavity were significantly negatively correlated with the endometrium thickness on HCG day ( P <0.05). The other factors including the location & number of polyps,and time interval from uterine recovery to embryo transfer were not associated with live birth ( P >0.05). Conclusions : Age,BMI,recovery time and endometrial thickness on HCG days are independent factors affecting the live birth rate after hysteroscopic polypectomy. Therefore,the clinicians should pay attention to individual conditions including age,BMI and other factors in order to promote postoperative uterine cavity recovery and enhance the live birth rate of IVF/ICSI in the infertility patients with endometrial polyps.