子宫内膜微搔刮联合药物治疗对改善AID生化妊娠史患者子宫内膜效果

Evaluation of the effect of endometrial micro stimulation combined with drug therapy for improving pregnancy outcomes of patients with AID biochemical pregnancy

目的:探讨供精人工授精(AID)周期中子宫内膜微搔刮联合改善内膜药物治疗对AID助孕后发生≥2次生化妊娠史患者子宫内膜形态学和妊娠结局影响。方法:2016年1月—2019年12月因男方不可逆性无精子症在本所临床医学中心接受AID治疗后发生≥2次生化妊娠患者78例,随机分为干预组(40例)和对照组(38例)。干预组再次AID治疗前月经周期窗口期行子宫内膜微搔刮,对照组不进行干预。两组AID治疗周期均采用自然周期,于排卵日前后各行1次AID手术。结果:78例中有5例因各种原因退出研究,最终纳入研究干预组38例、对照组35例。两组患者治疗前周期的HCG日子宫内膜厚度、A型内膜比率及窗口期子宫内膜厚度均无差异(P>0.05);与对照组相比,干预组治疗周期HCG日子宫内膜厚度(9.88±0.96 mm比8.93±0.49 mm)、A型内膜比率(84.2%比62.9%)及窗口期子宫内膜厚度(10.18±0.98 mm比9.43±0.44 mm)均高,治疗前后HCG日子宫内膜增厚幅度(1.27±0.77 mm比0.33±0.32 mm)、A型内膜增幅比率(26.3%比5.7%)及窗口期子宫内膜增厚幅度(0.85±0.52 mm比0.23±0.20 mm)均高,治疗周期临床妊娠率高(36.8%比14.3%(均P<0.05),生化妊娠率(0比5.71%)和流产率(0比20%)无差异(P>0.05)。结论:子宫内膜微搔刮及改善内膜药物的综合治疗,可以改善AID助孕后发生生化妊娠患者子宫内膜和临床妊娠结局。

Objective:To explore the influence of endometrial micro stimulation combined with drug therapy for improving pregnancy outcomes of patients with more than one time of biochemical pregnancy after artificial insemination with donor sperm(AID)on their endometrial morphology and pregnancy outcomes.Methods:A total of 78 patients who had two or more biochemical pregnancies after receiving AID treatment in our center were enrolled from January 2016 to December 2019.The patients were randomly divided into intervention group(n=40)and control group(n=38).The patients in the intervention group underwent endometrial scratching in mid-luteal phase before AID cycle,but which was not performed in the control group.AID operation was performed for the patients in the two groups before and after ovulation.After that,the patients in the intervention group were given drugs to improve their endometrial receptivity in the AID cycle,while the patients in the control group were not intervened.Results:5 cases in 78 patients had withdrawn from the study,and 38 patients in intervention group and 35 patients in control group were included in the study in the end.There were no significant differences in the indicators of endometrial ultrasound monitoring before AID treatment between the two groups(P>0.05).The endometrial thickness during treatment,the ratio of types A endometrium on the day of HCG trigger,and the endometrial thickness on the day of the window period of the patients in the intervention group were 9.88±0.96 mm,84.2%,and 10.18±0.98 mm,respectively,which were significant higher than those(8.93±0.49 mm,62.9%,and 9.43±0.44 mm)of the patients in the control group(P<0.05).After treatment,the increased amplitude of endometrial thickness,the ratio of types A endometrium on the day of HCG and the increased amplitude of endometrial thickness on the day of window period of the patients in the intervention group were 1.27±0.77,26.3%,and 0.85±0.52,respectively,which were significant higher than those(0.33±0.32,5.7%,and 0.23±0.20)of the patients in the control group(P<0.05).The clinical pregnancy rate during treatment(36.8%)of the patients in the intervention group was significant higher that(14.3%)of the patients in the control group(P<0.05).There were no significant differences in the biochemical pregnancy rate(0%vs.5.71%)and the miscarriage rate(0%vs.20%)between the two groups(P>0.05).Conclusion:The endometrial micro stimulation combined with drug therapy can improve the endometrial status and pregnancy outcomes of patients with AID biochemical pregnancy.