胚胎移植未孕史患者筛查慢性子宫内膜炎时机的探讨

Exploring the optimal time to screen for chronic endometritis in patients with previous unpregnant embryo transfer cycle

目的探讨既往有移植未孕史患者宫腔镜检查及子宫内膜活检筛查慢性子宫内膜炎的时机。方法回顾性队列研究分析2015年1月至2018年12月期间在北京大学第三医院妇产科生殖医学中心既往有胚胎移植未孕史患者,在下次冻融胚胎移植助孕前行或未行门诊宫腔镜检查同时子宫内膜活检检查患者的临床资料,共10218例。根据是否行宫腔镜检查及子宫内膜活检分为宫腔镜组(1848例)与对照组(8370例),并根据既往胚胎移植未孕次数进行组间比较。以活产率为主要终点指标,并对相关因素进行回归分析。结果既往有2次或3次胚胎移植未孕史患者慢性子宫内膜炎发生率较既往仅有1次胚胎移植未孕的患者高[47.3%(490/1035)、44.5%(182/409)比34.7%(140/404),P=0.002];既往不同移植未孕次数宫腔镜异常表现比例组间差异无统计学意义(P>0.05);既往胚胎移植未孕1次或2次患者,在下次冻融胚胎移植前是否行宫腔镜检查及子宫内膜活检对活产无明显影响(OR=1.158,95%CI=0.870~1.542,P>0.05;OR=0.950,95%CI=0.729~1.238,P>0.05),但既往胚胎移植未孕3次患者,在下次冻融胚胎移植前行宫腔镜检查及子宫内膜活检是活产的保护因素(OR=1.703,95%CI=1.008~2.876,P=0.047)。结论在B超未提示子宫内膜或宫腔形态异常情况下,有2次或以上移植未孕史患者可考虑通过宫腔镜检查及子宫内膜活检筛查慢性子宫内膜炎以改善妊娠结局。

Objective To explore the optimal time to screen for chronic endometritis by hysteroscopy and endometrial biopsy in patients with previous unpregnant embryo transfer cycle.Methods A retrospective cohort analysis of patients with unpregnant embryo transfer cycle whether perform hysteroscopy and endometrial biopsy or not before next frozen-thawed embryo transfer cycle was performed in the Reproductive Medical Center of the Peking University Third Hospital from January 2015 to December 2019,including 10218 patients.Patients were divided into hysteroscopy group(1848 cases)and control group(8370 cases)according to whether hysteroscopy was performed or not and subgroup analysis was performed according to the number of pregnancies in previous embryo transfer.The primary endpoint was live birth rate and the influencing factors were analyzed by regression analysis.Results The incidence of chronic endometritis was higher in patients with two or three previous unpregnant embryo transfer cycles than that in patients with only one unpregnant embryo transfer cycle[47.3%(490/1035),44.5%(182/409)vs.34.7%(140/404),P=0.002];there was no significant difference in the proportion of abnormal hysteroscopic findings among groups(P>0.05).For patients with one or two previous unpregnant embryo transfer cycles,whether perform hysteroscopy and endometrial biopsy or not before next frozen-thawed embryo transfer did not affect live birth(OR=1.158,95%CI=0.870-1.542,P>0.05;OR=0.950,95%CI=0.729-1.238,P>0.05),but hysteroscopy and endometrial biopsy was the protective factor for patients with 3 previous unpregnant ET cycles(OR=1.703,95%CI=1.008-2.876,P=0.047).Conclusion For patients with two or more previous unpregnant embryo transfer cycles and without positive findings in ultrasound,hysteroscopy and endometrial biopsy can be considered to screen for endometrial abnormalities.