基于宫腔镜诊断的慢性子宫内膜炎女性IVF-ET妊娠结局及风险因素分析

Pregnancy Outcomes and Risk Factors in Infertile Women Diagnosed with Chronic Endometritis by Hysteroscopy in IVF-ET

目的探究基于宫腔镜诊断的慢性子宫内膜炎(CE)女性体外受精-胚胎移植(IVF-ET)治疗后的妊娠结局及相关风险因素。方法回顾性分析2017年1月至2018年9月烟台市烟台山医院和烟台毓璜顶医院生殖医学中心经宫腔镜检查后行IVF-ET治疗的1648例鲜胚移植者的临床资料,其中宫腔镜诊断CE 429例、非CE 1219例。同时二次遴选标准化患者鲜胚移植497例,其中CE 140例、非CE 357例;鲜胚移植周期中移植优质胚胎的标准化患者436例,其中CE 116例、非CE 320例。观察CE组与非CE组临床妊娠结局,并通过多因素分析宫腔镜下CE的发病风险因素。结果鲜胚移植周期中,CE组与非CE组临床妊娠率、活产率、早产率、流产率比较差异均无统计学意义(P>0.05)。二次遴选鲜胚移植的标准化患者中,CE组临床妊娠率、活产率均低于非CE组[54.29%(76/140)比65.55%(234/357)、45.71%(64/140)比58.26%(208/357)](P<0.05),两组早产率、流产率比较差异无统计学意义(P>0.05)。优质胚胎移植的标准化患者中,CE组临床妊娠率、活产率低于非CE组[58.62%(68/116)比70.63%(226/320)、50.00%(58/116)比62.81%(201/320)](P<0.05),早产率高于非CE组[13.24%(9/68)比7.96%(18/226)](P<0.05),两组流产率比较差异无统计学意义(P>0.05)。鲜胚移植周期中,CE组多囊卵巢综合征、输卵管积水比例高于非CE组(P<0.01)。多因素Logistic回归分析结果显示,人工流产次数增加、临床存在多囊卵巢综合征和输卵管积水是宫腔镜下CE发生的独立危险因素(OR=1.447,95%CI 1.199~1.745;OR=2.418,95%CI 1.764~3.314;OR=2.268,95%CI 1.632~3.152)(P<0.01)。结论宫腔镜下CE与不孕女性IVF-ET不良妊娠结局密切相关,临床妊娠率及活产率降低,早产率升高,人工流产次数、输卵管积水和多囊卵巢综合征是宫腔镜下CE发生的独立危险因素,通过宫腔镜诊断CE可能更有利于评估CE对妊娠结局的影响。

Objective To investigate the pregnancy outcomes and risk factors after in vitro fertilization and embryo transfer(IVF-ET)in infertile women with chronic endometritis(CE)diagnosed by hysteroscopy.Methods Clinical data of 1648 cases with fresh embryo transplants who underwent IVF-ET treatment after hysteroscopy in Reproductive Medicine Center of Yantai City Yantaishan Hospital and Yantai Yuhuangding Hospital from Jan.2017 to Sep.2018 were retrospectively analyzed.Among them,429 cases of CE and 1219 cases of non-CE were diagnosed by hysteroscopy.At the same time,497 cases(including 436 cases of high quality)of fresh embryos of standardized patients were secondarily screened out,including 140 cases(including 116 cases of high quality)of CE and 357 cases(including 320 cases of high quality)of non-CE.Clinical pregnancy outcomes of CE group and non-CE group were observed,and the risk factors of hysteroscopic CE were analyzed by multivariate analysis.Results There were no significant differences in the clinical pregnancy rate,live birth rate,premature birth rate and abortion rate between the CE group and the non-CE group during the fresh embryo transplantation cycle(P>0.05).Among the secondarily screened standard patients,the clinical pregnancy rate and live birth rate in the CE group were lower than those in the non-CE group[54.29%(76/140)vs 65.55%(234/357),45.71%(64/140)vs 58.26%(208/357)](P<0.05),while there was no significant difference in the rate of premature birth and abortion between the two groups(P>0.05).Among the standard patients with high quality embryo implants,the clinical pregnancy rate and live birth rate in the CE group were lower than those in the non-CE group[58.62%(68/116)vs 70.63%(226/320),50.00%(58/116)vs 62.81%(201/320)](P<0.05),and the rate of premature birth was higher than that of the non-CE group[13.24%(9/68)vs 7.96%(18/226)](P<0.05).There was no significant difference in the rate of abortion between the two groups(P>0.05).During fresh embryo transfer cycle,the proportions of polycystic ovary syndrome and hydrosalpinx in the CE group was higher than those in the non-CE group(P<0.01).Multivariate Logistic regression analysis showed that increased number of induced abortion,polycystic ovarian syndrome and hydrosalpinx were independent risk factors for CE under hysteroscopy(OR=1.447,95%CI 1.199-1.745;OR=2.418,95%CI 1.764-3.314;OR=2.268,95%CI 1.632-3.152)(P<0.01).Conclusion CE under hysteroscopy is closely related to IVF-ET adverse pregnancy outcomes in infertility women,including decreased clinical pregnancy rate and live-birth rate significantly decreased and increased preterm birth rate.Number of induced abortion,hydrosalpinx and polycystic ovarian syndrome are the independent risk factors for CE under hysteroscopy,and the diagnosis of CE by hysteroscopy may be more helpful to assess the effect of CE on pregnancy outcome.