不同子宫内膜种植窗检测方法对反复种植失败患者妊娠结局的影响

Effect of Different Endometrial Implantation Window Detection Methods on Pregnancy Outcome in Patients with Repeated Implantation Failure

目的:采用子宫内膜容受性阵列(ERA)测序或子宫内膜组织学检测方法评估反复种植失败(RIF)患者子宫内膜种植窗,探讨两种技术对于改善此类患者临床结局的有效性及成本效益分析。方法:回顾性队列研究2018年1月至2022年12月在甘肃省妇幼保健院生殖医学中心诊断为RIF的125例患者的临床资料。根据是否接受子宫内膜容受性检测和使用检测技术不同,分为对照组(n=36)、基因组(n=35)和组织学组(n=54),比较3组临床资料和妊娠结局。结果:①单因素方差分析结果显示:基因组和组织学组患者的胚胎植入率显著高于对照组,差异有统计学意义(P<0.05),基因组与组织学组患者的胚胎植入率差异无统计学意义(P=0.48);②3组患者的临床妊娠率及活产率差异均无统计学意义(P>0.05);③Log-rank检验显示:基因组和组织学组患者50%达活产时间显著小于对照组,差异有统计学意义(P<0.05),基因组与组织学组50%患者达活产时间差异无统计学意义(P>0.05);④对照组患者平均移植胚胎数显著高于基因组和组织学组,差异有统计学意义(P<0.05),基因组患者花费成本显著高于组织学组,差异有统计学意义(P<0.05)。结论:①对于RIF的患者可行子宫内膜种植窗检测,可有效缩短达活产时间,减少移植胚胎数目;②ERA测序和子宫内膜组织学检测作为评估子宫内膜种植窗的方法均具有局限性,尚不能明确哪种检测方法在准确性和实用性方面更具有优势。

Objective:To evaluate the endometrial implantation window in patients with recurrent implantation failure using endometrial receptive array(ERA)sequencing or endometrial histological detection methods,and to explore the effectiveness and cost-effectiveness analysis of two technologies for improving clinical outcomes in such patients.Methods:A retrospective cohort study was conducted on clinical data of 125 patients diagnosed with repeated implantation failure in Gansu Maternal and Child Health Hospital from January 2018 to December 2022.According to whether endometrial receptivity testing was accepted and different detection techniques were used,they were divided into a control group(n=36),a genomic group(n=35),and a histological group(n=54).The clinical data and pregnancy outcomes of the three groups were compared.Results:①The results of one-way ANOVA showed that the embryo implantation rate in the genomic group and histological group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in embryo implantation rate between genomic and histological groups(P=0.48).②There was no statistically significant difference in clinical pregnancy rate and live birth rate among the three groups(P>0.05).③Log rank test showed:The time for 50%of patients to reach live labor was significantly shorter than that of the control group,and the difference was statistically significant(P<0.05);There was no statistically significant difference in the time to live birth in 50%of patients between the genomic and histological groups of 50%of patients(P>0.05).④The average number of embryos transferred in the control group was significantly higher than that in the genomic and histological groups,with statistical significance(P<0.05).The cost of genomic patients was significantly higher than that of histology group,and the difference was statistically significant(P<0.05).Conclusions:①Endometrial implantation window detection is feasible for patients with repeated implantation failure,which can effectively shorten the time to live birth and reduce the number of transplanted embryos;②Both ERA sequencing and endometrial histology detection have limitations as methods to evaluate endometrial implantation window,and it is not clear which detection method has more advantages in accuracy and practicability.