子宫内膜容受性超声指标对冻融胚胎移植结局的影响

Effect of endometrial receptivity ultrasonic indicators on the outcome of frozen-thawed embryo transfer

目的研究子宫内膜容受性的超声检测指标对冻融胚胎移植(FET)妊娠结局的影响。方法选取212例行FET治疗的患者,采用彩色多普勒超声检测转内膜日子宫内膜厚度及分型,转内膜3 d子宫动脉血流搏动指数(PI)、阻力指数(RI)及收缩期峰值流速与舒张末期流速比值(S/D),以及子宫内膜及内膜下血流分布,分析各指标与妊娠结局的关系。结果妊娠组与非妊娠组内膜厚度、子宫动脉血流参数差异均无统计学意义(P>0.05)。双侧或单侧子宫动脉舒张期血流缺失组在给予低分子肝素钙及他达拉非治疗后与未缺失组妊娠率差异无统计学意义(P>0.05)。子宫内膜及内膜下血流3种分型临床妊娠率、内膜厚度差异均有统计学意义(P<0.05):从Ⅰ型组到Ⅲ型组内膜厚度(mm)逐渐增高;Ⅱ型组、Ⅲ型组妊娠率(62.7%、60.9%)均显著高于Ⅰ型组(25.0%)。结论子宫内膜和内膜下血流分型对FET结局有预测的作用,而单纯子宫内膜厚度和子宫动脉血流参数无预测价值。

Objective To study the effect of endometrial receptivity ultrasonic indicators on the pregnancy outcome of frozen-thawed embryo transfer(FET).Methods A total of 212 patients who underwent FET in our department were selected.The endometrial thickness and classification,the pulsatility index(PI),resistance index(RI),the ratio of peak systolic velocity to end diastolic velocity(S/D)of the uterine artery blood on day 3 of endometrium transformation,as well as the endometrial and sub-endometrial blood flow perfusion were measured by color Doppler ultrasound.The correlation of each index with the pregnancy outcome was analyzed.Results There were no significant differences in the endometrial thickness and uterine artery blood flow parameters between pregnancy group and non-pregnancy group(P>0.05).There was no significant difference in the rate of pregnancy between patients with bilateral or unilateral loss of diastolic blood flow in the uterine artery who were treated with the Low Molecular Weight Heparin Calcium and Tadalafil and those with the loss of diastolic blood flow(P>0.05).There were significant differences in the rate of clinical pregnancy and endometrial thickness among three types of endometrial and sub-endometrial blood flow(P<0.05).The endometrial thickness increased gradually from typeⅠto typeⅢgroup([9.017±1.203]mm,[9.339±1.758]mm,[10.520±1.938]mm).The pregnancy rates of typeⅡand typeⅢgroup(62.7%and 60.9%)were significantly higher than that of typeⅠgroup(25.0%).Conclusion The type of endometrial and sub-endometrial blood flow can predict outcome of FET,but endometrial thickness and uterine artery blood flow parameters alone have no predictive value.