新鲜胚胎移植周期子宫内膜容受性超声指标与妊娠结局关系分析

Relationship between ultrasound parameters of endometrial receptivity and pregnancy outcome in fresh embryo transfer cycle

目的探讨体外受精-胚胎移植技术(IVF-ET)新鲜移植周期中子宫内膜容受性超声指标与妊娠结局的关系。方法回顾性分析我院生殖医学科自2020年8月至2022年2月采用早卵泡期长方案促排卵的278个IVF新鲜移植周期,根据是否临床妊娠分为妊娠组(n=157)和非妊娠组(n=121),比较两组间取卵后第3日三维多普勒能量超声检测子宫内膜厚度、宫腔容积、子宫动脉和子宫内膜下血流各参数之间的差异。结果妊娠组的子宫内膜厚度[(12.3±2.2)mm]和宫腔容积[(6.2±2.4)ml]均显著高于非妊娠组[分别为(11.0±1.6)mm和(4.3±1.4)ml,P<0.05];妊娠组子宫内膜下血流分布Ⅰ型占比显著低于非妊娠组(31.8%vs.44.6%,P<0.05);两组间双侧子宫动脉血流搏动指数、阻力指数均无统计学差异(P>0.05);妊娠组子宫内膜下血流血管化指数、血流指数、血管化血流指数值虽高于非妊娠组,但差异无统计学意义(P>0.05)。进一步二元Logistic回归分析,提示宫腔容积、内膜下血流分布是临床妊娠率的影响因素(P<0.05)。结论取卵后第3日宫腔容积和内膜下血流分布情况可能是鲜胚移植妊娠结局的影响因素。

Objective:To investigate the relationship between ultrasound parameters of endometrial receptivity and clinical pregnancy rate in fresh embryo transfer of IVF-ET cycles.Methods:The data of 278 IVF fresh embryo transfer cycles with early follicular phase long protocol for ovarian stimulation in the Department of Reproductive Medicine of our hospital from August 2020 to February 2022 were retrospectively analyzed.The patients were divided into pregnancy group(n=157)and non-pregnancy group(n=121)according to whether they were pregnant or not.The endometrial thickness,uterine cavity volume,uterine artery and sub-endometrial blood flow parameters detected by three-dimensional Doppler energy ultrasound on the third day after oocyte retrieval,and the ultrasound parameters were compared between the two groups.Results:The endometrial thickness[(12.3±2.2)mm vs.(11.0±1.6)mm]and the uterine cavity volume[(6.2±2.4)ml vs.(4.3±1.4)ml]of the pregnancy group were significantly higher than those of the non-pregnancy group(P<0.05).The proportion of type I subintimal blood flow distribution in the pregnancy group was significantly lower than that in the non-pregnancy group(31.8%vs.44.6%)(P<0.05).However,there was no significant difference in uterine artery blood flow pulsatility index and resistance index between the two groups(P>0.05).Although the values of sub-endometrial blood flow vascularization index(VI),blood flow index(FI)and vascularization blood flow index(VFI)in pregnancy group were higher than those in non-pregnancy group,but there was no significant difference(P>0.05).Further binary Logistic regression analysis showed that uterine cavity volume and subintimal blood flow distribution were the influencing factors of clinical pregnancy rate(P<0.05).Conclusions:Uterine cavity volume and subintimal blood flow distribution on the third day after oocyte retrieval may be influencing factors of pregnancy outcomes in fresh embryo transfer.