无宫腔受压的子宫肌壁间肌瘤对辅助生殖妊娠结局的影响

Impact of non-cavity-distorting intramural fibroids on outcome of assisted reproductive pregnancy

目的探讨无宫腔受压的子宫肌壁间肌瘤对不孕女性辅助生殖妊娠结局的影响。方法回顾性分析2017年1月至2020年12月在北部战区总医院生殖医学科行IVF-ET的患者临床资料。按照是否存在子宫肌瘤将患者分为肌瘤组(189例患者,372个周期)和无肌瘤组(189例患者,297个周期),比较两组患者的一般资料、促排卵及胚胎移植情况、妊娠结局,采用多因素Logistic回归分析无宫腔受压肌壁间肌瘤与妊娠结局的关系。结果两组患者的一般资料比较,除肌瘤组女方年龄显著高于无肌瘤组(P<0.05)外,其余指标均无显著性差异(P>0.05)。两组患者促排卵方案、获卵数、移植胚胎数、移植日内膜厚度、内膜分型等比较均无显著性差异(P>0.05)。肌瘤组的临床妊娠率(46.8%vs.57.9%)和活产率(32.8%vs.46.8%)显著低于无肌瘤组(P<0.05),自然流产率(29.9%vs.19.2%)显著高于无肌瘤组(P<0.05)。多因素Logistic回归分析中,调整相关混杂因素后,肌壁间肌瘤仍然是影响临床妊娠率和活产率的独立危险因素(P<0.05);与无肌瘤组相比,肌壁间肌瘤可以使临床妊娠率和活产率显著降低(P<0.05)。首次胚胎移植周期中两组患者的活产率比较无显著性差异(P>0.05),第2~4次移植周期中无肌瘤组的累加活产率均显著高于肌瘤组患者(P<0.05)。结论无宫腔受压的肌壁间肌瘤对辅助生殖妊娠结局有显著不良影响,可降低临床妊娠率和活产率,增加自然流产率;且单纯增加移植次数对活产率的改善不明显。

Objective:To investigate the impact of non-cavity-distorting intramural fibroids on the outcome of assisted reproductive pregnancy in infertile women.Methods:The clinical data of patients who underwent IVF-ET at the Department of Reproductive Medicine in the General Hospital of the Northern Theater Command from January 2017 to December 2020 were retrospectively analyzed.According to the presence or absence of uterine fibroids,the patients were divided into fibroid group(189 patients,372 cycles)and non-fibroid group(189 patients,297 cycles).The general information,ovulation induction,embryo transfer and pregnancy outcome were compared between the two groups.The relationship between non-cavity-distorting intermural fibroids and pregnancy outcome was analyzed by multivariate logistic regression.Results:When the general information of the two groups were compared,there was no significant difference in other indicators(P>0.05)except for the age of women in the fibroid group was significantly higher than that in the non-fibroid group(P<0.05).There were no significant differences in ovulation induction protocols,number of oocytes retrieved,number of embryos transferred,endometrial thickness on transfer day and endometrial type between the two groups(P>0.05).The clinical pregnancy rate(46.8%vs.57.9%,P<0.05)and live birth rate(32.8%vs.46.8%,P<0.001)of the fibroid group were significantly lower than those of the non-fibroid group,and the miscarriage rate(29.9%vs.19.2%,P<0.05)was significantly higher than that of the non-fibroid group.In the multivariate Logistic regression analysis,intramural fibroids remained an independent risk factor for clinical pregnancy rate and live birth rate after adjusting for relevant confounding factors(P<0.05).Intramural fibroids could significantly reduce clinical pregnancy rate and live birth rate compared with the non-fibroid group(P<0.05).There was no significant difference in the live birth rate between the two groups in the first embryo transfer cycle(P>0.05),and the cumulative live birth rate in the non-fibroid group in the 2 nd-4 th embryo transfer cycle was significantly higher than that in the fibroid group(P<0.05).Conclusions:Non-cavity-distorting intramural fibroids have a significant adverse effect on the outcome of assisted reproductive pregnancy,reducing the clinical pregnancy rate and live birth rate,and increasing the miscarriage rate.Simply increasing the number of embryo transfer cycles does not significantly improve the live birth rate.