子宫腺肌病病灶位置与IVF-ET结局的相关性研究

Study on the correlation between the location of adenomyosis and the outcome of in vitro fertilization-embryo transfer

目的探讨子宫腺肌病患者病灶位置对体外受精-胚胎移植(IVF-ET)结局的影响。方法选取唐山市妇幼保健院2019年10月至2022年10月收治的335例有妊娠意愿的子宫腺肌病患者作为研究对象。所有患者均进行磁共振成像检查,根据病灶位置将患者分为肌层组(病灶累及子宫肌层)、浆膜组(病灶位于子宫浆膜侧)和内膜组(病灶位于子宫内膜侧)。比较三组患者行IVF-ET的妊娠率、流产率和最终活产率。结果最终280例患者纳入研究,包括178例肌层组,70例浆膜组和32例内膜组。浆膜组患者IVF-ET后的流产率显著低于肌层组和内膜组(P<0.05),且最终活产率显著高于肌层组和内膜组(P<0.05)。二元Logistic回归分析显示,与肌层组相比,浆膜组患者IVF-ET后的流产风险小(OR=0.07,95%CI:0.00~0.62,P=0.014)且活产率较高(OR=8.38,95%CI:1.47~31.38,P=0.020)。结论子宫腺肌病病灶位置会影响IVF-ET结局,评估子宫腺肌病病灶位置有助于确定治疗方案。

Objective To investigate the effect of lesion location on the outcome of in vitro fertilizationembryo transfer(IVF-ET)in patients with adenomyosis.Methods A total of 335 patients with adenomyosis who were admitted to Tangshan Maternal and Child Health Hospital from October 2019 to October 2022 with pregnancy intention were selected as subjects.All patients underwent magnetic resonance imaging and were divided into myometrium group(lesions involving the myometrium),serous group(lesions located on the serous side of the uterus),and endometrium group(lesions located on the endometrial side)according to lesion location.The pregnancy rate,abortion rate and final live birth rate of the three groups were compared.Results A total of 280 patients were finally included in the study,including 178 in the myometrium group,70 in the serous group and 32 in the endometrium group.The abortion rate in serous group was significantly lower than that in the other two groups(P<0.05),and the final live birth rate was significantly higher than that in myometrium group and endometrium group(P<0.05).Binary Logistic regression analysis showed that the risk of miscarriage after IVFET in the serous group was lower(OR=0.07,95%CI:0.00-0.62,P=0.014)and the live birth rate was higher(OR=8.38,95%CI:1.47-31.38,P=0.020).Conclusions Adenomyosis lesion location could affect IVF-ET outcome,and evaluation of adenomyosis lesion location could help determine treatment options.