宫腔内注射人绒毛膜促性腺激素在初次体外受精-胚胎移植患者改善妊娠结局中的应用价值

Application Value of Intrauterine Injection of Human Chorionic Gonadotropin on Improving Pregnancy Outcomes in Patients with Primary In Vitro Fertilization-embryo Transfer

目的:探讨宫腔内注射人绒毛膜促性腺激素(HCG)在初次体外受精-胚胎移植(IVF-ET)患者改善妊娠结局中的应用价值。方法:选取经本院收治行初次IVF-ET患者115例作为研究对象,均接受促性腺激素释放激素激动剂(GnRH-a)长方案调节治疗,其中将ET前15 min进行宫腔内注射HCG治疗设置为观察组(n=60例),于ET前15 min不作任何处理设为对照组(n=55例),比较两组子宫内膜容受性及妊娠结局,根据妊娠与否将观察组分作妊娠组及非妊娠组,分析子宫内膜容受性变化与妊娠的关系。结果:两组子宫内膜分型、子宫内膜体积、子宫内膜厚度比较,差异无统计学意义(P>0.05),除S/D、VI外,观察组PI、RI低于对照组,FI及VFI高于对照组(P<0.05);观察组胚胎种植率、临床妊娠率依次为56.67%、70.00%,高于对照组的36.36%、50.91%(P<0.05);两组早期流产率比较,差异无统计学意义(P>0.05)。经单因素分析显示,妊娠组PI、RI低于非妊娠组,FI、VFI高于非妊娠组(P<0.05);多因素Logistic回归分析显示,影响宫腔内注射hCG治疗IVF-ET患者妊娠结局独立性危险因素为PI、RI、FI及VFI;ROC曲线分析显示,PI、RI、FI及VFI单一预测IVF-ET患者妊娠结局AUC值为0.738~0.800,而PI、RI、FI及VFI联合预测AUC值达0.909,预测价值最高,此时,灵敏度、特异度分别为95.24%、83.33%。结论:初次IVFET患者于宫腔内注射HCG可一定程度改善子宫内膜容受性,进而提高胚胎种植率及临床妊娠率,且于IVFET后使用超声检查监测子宫内膜容受性变化,便于为治疗方案选择提供关键指导。

Objective:To investigate the application value of intrauterine injection of human chorionic gonadotropin(HCG)on improving the pregnancy outcomes in patients with primary in vitro fertilization-embryo transfer(IVF-ET).Methods:A total of 115 patients with primary IVF-ET who were admitted to the hospital were enrolled as the study subjects,and all received gonadotropin-releasing hormone agonist(GnRH-a)long-term adjustment therapy.Patients with intrauterine injection of HCG treatment at 15 min before ET were set as the observation group(n=60),and patients without any treatment at 15 min before ET were regarded as the control group(n=55).The endometrial receptivity and pregnancy were compared between the two groups.The patients in observation group were further classified into pregnancy group and non-pregnancy group according to the presence or absence of pregnancy,and the relationship between the changes of endometrial receptivity and pregnancy was analyzed.Results:There were no statistical differences in endometrial type,endometrial volume and endometrial thickness between the two groups(P>0.05).Except for S/D and VI,the PI and RI of the observation group were lower while the FI and VFI were higher than those of the control group(P<0.05).The embryo implantation rate and clinical pregnancy rate were 56.67% and 70.00% in the observation group,which were higher than 36.36% and 50.91% in the control group(P<0.05).There was no statistical significance in the early miscarriage rate between the two groups(P>0.05).According to univariate analysis,the PI and RI in the pregnancy group were lower than those in the non-pregnancy group while the FI and VFI were higher than those in the non-pregnancy group(P>0.05).Multivariate Logistic regression analysis revealed that the independent risk factors affecting pregnancy outcomes of IVF-ET patients treated by intrauterine injection of HCG were PI,RI,FI and VFI.ROC curve analysis showed that the AUC values of PI,RI,FI and VFI alone on predicting the pregnancy outcomes in patients with IVF-ET ranged from 0.738 to 0.800,but the AUC value of combined detection of PI,RI,FI and VFI reached 0.909 with the highest predictive value,and the sensitivity and specificity were 95.24% and 83.33% respectively.Conclusion:Intrauterine injection of HCG can improve endometrial receptivity to a certain extent in patients with primary IVF-ET,thereby increasing the embryo implantation rate and clinical pregnancy rate.Ultrasonography after IVF-ET can monitor the changes of endometrial receptivity in order to provide key guidance on treatment options.