经阴道超声检测子宫内膜蠕动波在冻融胚胎移植周期中的应用价值

Application value of transvaginal ultrasonography in detecting endometrial peristalsis wave during freeze-thaw embryo transfer cycle

目的探讨经阴道超声检测子宫内膜蠕动波在冻融胚胎移植周期中的应用价值。方法选取2020年1月至2021年1月在西京医院妇产科生殖中心接受替代方案冻融胚胎移植的124个周期,根据是否临床妊娠分为妊娠组(62个周期)和未妊娠组(62个周期),两组在患者年龄、不孕年限、体质量指数、抗缪勒管激素、移植胚胎数、移植优质胚胎率方面均无明显差异(P>0.05),具可比性。除常规监测子宫内膜厚度、分型及内膜血流分型外,两组在移植前日均经阴道超声检测子宫内膜蠕动波频率与方向,并回顾性分析比较两组差异情况。结果妊娠组转化日子宫内膜较未妊娠组厚,差异有统计学意义(P<0.05);A型内膜比率、A型血流比率均高于未妊娠组,B型内膜比率、B型血流比率均低于未妊娠组,但均无显著差异(P>0.05);妊娠组移植前日子宫内膜蠕动波频率明显低于未妊娠组(P<0.05),宫颈至宫底波、无运动波占比显著高于未妊娠组(P<0.05),方向不定的随机波占比显著低于未妊娠组(P<0.05),其余方向波型均低于未妊娠组,但无统计学差异(P>0.05)。结论经阴道超声检测子宫内膜蠕动波作为一种无创检查方法,可用于预测冻融胚胎移植周期结局,并与子宫内膜厚度、分型及血流分型等指标结合,指导临床选择最佳胚胎移植时机和适当干预措施,进一步提高临床妊娠率。

Objective To investigate the application value of transvaginal ultrasonography in detecting endometrial peristalsis wave during freeze-thaw embryo transfer cycle.Methods From January 2020 to January 2021,124 cycles of freeze-thaw embryo transfer in the Reproductive Center of Department of Obstetrics and Gynecology of Xijing Hospital were selected and divided into pregnant group(62 cycles)and non-pregnant group(62 cycles)according to clinical pregnancy.There were no significant differences between the two groups in patient age,duration of infertility,body mass index,anti-Müllerian hormone,number of embryos transferred and rate of high-quality embryos transferred(P>0.05),indicating comparability.In addition to routine monitoring of endometrial thickness and classification and classification of endometrial blood flow,the frequency and direction of endometrial peristalsis wave were detected by transvaginal ultrasonography on the day before transplantation in the two groups,and the differences between the two groups were retrospectively analyzed and compared.Results The endometrium in pregnant group was thicker than that in non-pregnant group on the transplantation day,and the difference was statistically significant(P<0.05).The ratio of type A endometrium and the ratio of type A blood flow in pregnant group were higher than those in non-pregnant group,while the ratio of type B endometrium and the ratio of type B blood flow in pregnant group were lower than those in non-pregnant group,but there were no significant differences(P>0.05).The frequency of endometrial peristalsis wave on the day before transplantation in pregnant group was significantly lower than that in non-pregnant group(P<0.05),the proportion of cervix to fundus wave and no motion wave in pregnant group was significantly higher than that in non-pregnant group(P<0.05),the proportion of random wave with indeterminate direction was significantly lower than that in non-pregnant group(P<0.05),and the wave patterns in other directions were lower than those in non-pregnant group,but there was no statistical difference(P>0.05).Conclusion As a non-invasive examination method,transvaginal ultrasonography in detection of endometrial peristaltic wave can be used to predict the outcome of freeze-thaw embryo transfer cycle.Combined with endometrial thickness,classification and blood flow classification,it can guide clinical selection of the best timing for embryo transfer and appropriate intervention measures,and further improve the clinical pregnancy rate.