体外受精-胚胎移植反复着床失败的影响因素及其与子宫内膜内皮型一氧化氮合酶表达水平的相关性

Influencing Factors of Repeated Implantation Failure in In-Vitro Fertilization-embryo Transfer and its Correlation with Endometrial Endothelial Nitric Oxide Synthase

【目的】探讨体外受精-胚胎移植(IVF-ET)反复着床失败的影响因素及其与子宫内膜内皮型一氧化氮合酶(eNOS)表达水平的相关性。【方法】回顾性分析2018年1月至2021年1月在本院行IVF-ET助孕的88例患者的临床资料,根据助孕结果,将第一周期行IVF-ET助孕成功者设为妊娠成功组(56例),将≥2次助孕新鲜周期仍不孕者设为妊娠失败组(32例)。采用Logistic回归分析IVF-ET反复着床失败的影响因素;所有患者均在胚胎移植前1周期着床窗口期对子宫内膜进行取样,采用反转录-聚合酶链反应检测eNOS mRNA表达水平,采用受试者工作曲线(ROC)分析eNOS mRNA表达水平对IVF-ET反复着床失败的预测价值。【结果】妊娠成功组患者流产史构成比及不育年限、HCG日雌二醇、eNOS mRNA表达与妊娠失败组患者比较,差异均有统计学意义(P<0.05);Logistic多因素回归分析结果显示:eNOS mRNA表达水平、不育年限、HCG日雌二醇水平均是IVF-ET反复着床失败的影响因素(P<0.05);ROC分析显示:eNOS mRNA表达水平预测IVF-ET反复着床失败的最佳截断点为0.47,灵敏度为91.07%,特异度为87.50%,曲线下面积(AUC)为0.892。【结论】IVF-ET反复着床失败与eNOS mRNA表达水平有关,且eNOS mRNA表达水平、不育年限、流产史均是IVF-ET反复着床失败的影响因素,临床检测eNOS mRNA表达水平可预测IVF-ET妊娠成功与否。

【Objective】To explore the influencing factors of repeated implantation failure in in-vitro fertilization-embryo transfer(IVF-ET)and its correlation with endometrial endothelial nitric oxide synthase(eNOS).【Methods】To retrospectively analyze the clinical data of 88 patients who underwent in-vitro fertilization-embryo transfer assisted conception at the Reproductive Medicine Center of our hospital from January 2018 to January 2021.According to the results of fertility,the first cycle of in-vitro fertilization-embryo transfer assisted pregnancy was set as the successful pregnancy group(n=56 cases),those who were still infertile after≥2 fresh cycles of assisted fertilization were set as the pregnancy failure group(n=32 cases).Logistic regression was used to analyze the related factors affecting pregnancy failure in patients with in vitro fertilization-embryo transfer implantation failures,the endometrium of all patients was sampled during the implantation window period of 1 cycle before embryo transfer,Reverse transcription-polymerase chain reaction was used to detect eNOS mRNA expression,the receiver operating curve(ROC)was used to analyze the value of eNOS mRNA expression level in predicting the pregnancy success of patients with in vitro fertilization-embryo transfer implantation failures.【Results】Compared with patients in the pregnancy failure group,there were statistically significant differences in the composition ratio of miscarriage history,the length of infertility,estradiol level on HCG day,eNOS mRNA expression in the successful pregnancy group(P<0.05).Logistic multivariate regression analysis showed that the expression level of eNOS mRNA,the length of infertility,and the estradiol level on HCG day were all effect factors affecting pregnancy failure in patients with in vitro fertilization-embryo transfer implantation failures(P<0.05).ROC analysis showed that eNOS mRNA expression level predicts the best cut-off point for pregnancy success in patients with in vitro fertilization-embryo transfer implantation failure was 0.47,the sensitivity was 91.07%,the specificity was 87.50%,and the area under the curve(AUC)was 0.892.【Conclusion】In vitro fertilization-embryo transfer implantation failures are related to eNOS mRNA expression levels,and eNOS mRNA expression levels,infertility years,and miscarriage history are all effect factors that affect pregnancy failure in patients with in vitro fertilization-embryo transfer implantation failures.Clinical detection of eNOS mRNA expression level can be used as a sensitive indicator for predicting pregnancy success in patients with in vitro fertilization-embryo transfer implantation failures.