子宫体积对子宫腺肌病合并不孕症患者新鲜胚胎移植临床结局的影响

Effect of uterine volume on fresh embryo transfer outcomes in infertile patients with adenomyosis

目的探讨胚胎移植前子宫体积对子宫腺肌病患者新鲜胚胎移植临床结局的影响。方法回顾性队列研究2009年1月至2018年12月期间年龄≤40岁因子宫腺肌病合并不孕症于北京大学第三医院妇产科生殖医学中心首次行超长方案体外受精/卵胞质内单精子注射-胚胎移植(in vitro fertilization/intracytoplasmic sperm injection-embryo transfer, IVF/ICSI-ET)助孕患者的临床资料。根据移植前子宫体积将研究对象分为A组(56~90 cm3,子宫体积如妊娠6周之内)、B组(90~130 cm3,子宫体积如妊娠6~8周)和C组(≥130 cm3,子宫体积如妊娠8周以上),比较不同子宫体积对临床结局的影响。logistic回归分析移植前子宫体积与临床结局的相关性。结果共纳入232名患者,其中A组153例、B组52例、C组27例。三组患者的年龄、体质量指数(body mass index, BMI)、基础卵泡刺激素(follicle-stimulating hormone, FSH)水平、窦卵泡数、不孕类型、子宫内膜厚度、获卵数、受精方式、可移植胚胎数与移植胚胎数差异均无统计学意义(P均>0.05)。三组患者的临床妊娠率差异无统计学意义(P>0.05)。A组流产率为24.59%(15/61),B组流产率为64.71%(11/17),C组流产率为55.56% (5/9),组间比较差异有统计学意义(P=0.004)。B组的活产率[11.54%(6/52)]低于A组[30.07% (46/153)],差异有统计学意义(P=0.009)。logistic回归分析结果显示,移植前子宫体积与临床妊娠率无显著相关性(OR=0.762, 95%CI=0.481~1.208,P=0.248),与流产率呈显著正相关(OR=2.822, 95%CI=1.165~6.835,P=0.022),与活产率呈显著负相关(OR=0.458, 95%CI=0.238~0.881,P=0.019)。结论子宫腺肌病合并不孕症患者胚胎移植前子宫体积增大(尤其是>90 cm3)时流产率增加,活产率降低。提示对于子宫腺肌病患者控制子宫体积仍是提高IVF-ET临床结局的关键。

Objective To investigate the impact of uterine volume prior to fresh embryo transfer on reproductive outcomes in infertile patients with adenomyosis.Methods A retrospective cohort study was conducted for the clinical data of patients diagnosed with adenomyosis and aged≤40 years undergoing in vitro fertilization/intracytoplasmic sperm injection-embryo transfer(IVF/ICSI-ET)with ultra-long downregulation stimulation protocol in Center for Reproductive Medicine,Department of Obstetrics and Gynecology of Peking University Third Hospital between January 2009 and December 2018.Logistic regression model was used to analyze the correlation between uterine volume and clinical outcomes.Study subjects were divided into three groups based on uterine volume before embryo transfer:group A 56-90 cm3(equivalent to uterine size within 6 weeks of pregnancy);group B 90-130 cm3(equivalent to 6-8 weeks gestation);group C≥130 cm3(equivalent to uterine size greater than 8 weeks gestation),the effect of uterine volume on clinical outcomes was compared.Results Totally 232 patients were included,153 patients in group A,52 patients in group B,27 patients in group C.The data showed no statistical difference among the three groups in basic characteristics(P>0.05).There was no significant difference in clinical pregnancy rate among three groups(P>0.05).The incidence of miscarriage among three groups were significantly different[group A,24.59%(15/61);group B,64.71%(11/17);group C,55.56%(5/9),P=0.018].Compared with group A[30.07%(46/153)],the live birth rate of group B[11.54%(6/52)]was significantly reduced(P=0.009).Logistic regression analysis showed that uterine volume before ET was not related to clinical pregnancy rate(OR=0.762,95%CI=0.481-1.208,P=0.248),and was positively related to miscarriage rate(OR=2.822,95%CI=1.165-6.835,P=0.022)while negatively correlated with live birth rate(OR=0.458,95%CI=0.238-0.881,P=0.019).Conclusion An increased level of uterine volume prior to embryo transfer(especially larger than 90 cm3)increases miscarriage rate and reduces the live birth rate in infertile patients with adenomyosis.Therefore,controlling uterine volume is still a key to improve the clinical outcome of IVF-ET in adenomyosis patients.