子宫内膜增生患者IVF-ET的妊娠结局分析

Analysis of clinical outcomes of IVF-ET in infertile patients with endometrial hyperplasia

目的通过倾向评分匹配(PSM)探讨不孕症合并子宫内膜增生患者经药物治疗后体外受精-胚胎移植(IVF-ET)的临床结局及影响疾病复发的因素。方法回顾性分析2014年6月至2019年6月于天津市中心妇产科医院因不孕症行IVF-ET助孕患者的临床资料,匹配前对照组755例(A组),子宫内膜增生组78例(B组),通过PSM后两组各52例,观察两组患者行IVF-ET的妊娠结局;根据子宫内膜增生患者的病理类型不同将B组又分为子宫内膜增生不伴不典型增生组(B1组,55例)和子宫内膜增生伴有不典型增生组(B2组,23例),分析影响患者复发的因素。结果匹配前两组患者的取卵年龄、体重指数(BMI)、不孕年限、原发性不孕比例、合并多囊卵巢综合征(PCOS)比例、基础E 2(bE 2)水平比较均具有统计学差异(P<0.05);匹配后两组患者的bE 2水平具有统计学差异(P<0.05),其余各项指标均无显著性差异(P>0.05)。匹配前两组患者的晚期流产率有统计学差异(P<0.05),匹配后两组患者的各项妊娠结局指标均无统计学差异(P>0.05)。Logistic回归分析显示累积妊娠率与患者取卵年龄[(P=0.005,OR=0.789,95%CI(0.670,0.930)]及获卵数[(P=0.024,OR=1.078,95%CI(1.010,1.150)]有关。B1组1~6年复发率显著低于B2组(5.5%vs.21.7%,P=0.016)。Logistic回归分析显示复发与病理类型有关[(P=0.018,OR=0.101,95%CI(0.015,0.680)]。结论不孕症合并子宫内膜增生患者经药物治疗后不降低IVF-ET的累积临床妊娠率及累积活产率,且不增加孕期并发症的发生率及新生儿体重,但随着年龄增加及卵巢储备功能下降,累积妊娠率明显下降。因此,临床工作中为改善该类患者的助孕结局及延缓疾病复发,建议药物治疗后应尽早行IVF治疗。

Objective:To investigate the clinical outcomes of IVF-ET in infertile patients with endometrial hyperplasia after drug therapy and the factors affecting the disease recurrence through Propensity Score Matching(PSM).Methods:The clinical data of infertile patients undergone IVF-ET in Tianjin Central Obstetrics and Gynecology Hospital from June 2014 to June 2019 were retrospectively analyzed.There were 755 patients in the control group(group A)and 78 patients in the endometrial hyperplasia group(group B)before construction of PSM algorithm.After passing PSM,52 patients were in each group.The outcomes of IVF-ET of the two groups were observed.According to the pathological type of endometrial hyperplasia,the patients were divided into endometrial hyperplasia without atypical hyperplasia group(group B1,n=55)and endometrial hyperplasia with atypical hyperplasia group(group B2,n=23).The factors affecting the disease recurrence were analyzed.Results:The differences of age,BMI,infertility duration,proportion of primary infertility,proportion of patient with PCOS and basal estradiol levels between two groups were significantly different before PSM(P<0.05).After construction of PSM algorithm,there were no significant differences in the indicators except for the level of basal estradiol between the two groups.There was a significant difference in the late abortion rate between two groups before PSM(P<0.05),but there were no significant differences in the pregnancy outcomes between the two groups after PSM(P>0.05).Logistic regression analysis showed that cumulative pregnancy rate was related to the patients’age at the time of oocyte retrieval[P=0.005,OR=0.789,95%CI(0.670,0.930)]and number of oocytes retrieved[P=0.024,OR=1.078,95%CI(1.010,1.150)].The recurrence rate from one to six years in group B1 was significantly lower than that in group B2(5.5%vs.21.7%,P=0.016).Logistic regression analysis showed that the disease recurrence was only related to pathological type[P=0.018,OR=0.101,95%CI(0.015,0.680)].Conclusions:Drug therapy does not reduce the cumulative pregnancy rate and cumulative live birth rate of IVF-ET in infertile patients with endometrial hyperplasia,and does not increase the incidence of pregnancy complications and the weight of newborns.However,the cumulative pregnancy rate significantly decreased with increase of age and decrease of ovarian reserve.Therefore,IVF treatment should be performed as soon as possible after drug therapy in order to improve IVF outcome and delay the disease recurrence or progression.