宫腔镜子宫内膜息肉手术后冻融胚胎移植时机对妊娠结局的影响

The Effect of Time Interval between Hysteroscopic Polypectomy and Start of Frozen-Thawed Embryo Transfer Cycles on Pregnancy Outcomes

目的:探讨宫腔镜子宫内膜息肉手术至术后第1次冻融胚胎移植(frozen-thawed embryo transfer,FET)周期的间隔时间对妊娠结局的影响。方法:回顾性分析2021年1月—2023年7月在南京医科大学附属妇产医院进行FET治疗的患者临床资料,入组患者在体外受精-胚胎移植(in vitro fertilization-embryo transfer,IVF-ET)周期因内膜因素采用了全胚胎冷冻,后行宫腔镜子宫内膜息肉切除术,并在术后进行第1次FET。根据宫腔镜子宫内膜息肉手术后FET时机分为3组:息肉术后第1次月经来潮后FET治疗组(A组)303个周期、息肉术后第2次月经来潮后FET治疗组(B组)159个周期、息肉术后第3~6次月经来潮后FET治疗组(C组)79个周期。结果:C组患者有剖宫产手术史者占比与A组相似,但高于B组,3组比较差异有统计学意义(16.5%vs.9.9%vs.6.3%,P=0.045)。3组患者的其他临床资料比较,差异无统计学意义(均P>0.05)。与A组和C组相比,B组的种植率(58.8%vs.48.0%vs.34.1%,P<0.001)和临床妊娠率(75.5%vs.63.0%vs.50.6%,P<0.001)明显升高。B组的持续妊娠率与A组相似,但明显高于C组(67.3%vs.57.1%vs.46.8%,P=0.008)。3组的早期流产率差异无统计学意义(P=0.869)。二元Logistic回归校正混杂因素后,3组的持续妊娠率差异无统计学意义(P>0.05)。结论:宫腔镜子宫内膜息肉手术后第1次月经来潮进行FET治疗的妊娠结局与延迟治疗类似,为减少患者等待过程中的精神负担并缩短到达妊娠的时间,推荐息肉术后尽快安排FET治疗。

Objective:To investigate whether the time interval between hysteroscopic polypectomy and the start of frozen-thawed embryo transfer(FET)cycles affect pregnancy outcomes.Methods:This was a retrospective clinical study conducting FET treatment between January 2021 and July 2023.All patients adopted the freeze-all strategy due to abnormal endometrium condition during in vitro fertilization-embryo transfer(IVF-ET)cycles.Subsequently,they were diagnosed as endometrial polyps and underwent hysteroscopic polypectomy before the first FET.Participants were divided into three groups,based on the time interval between hysteroscopic polypectomy and the start of FET cycle.Group A consisted of women who underwent FET after their next menses(n=303),group B after two menstrual cycles(n=159),and group C after three to six menstrual cycles(n=79).Results:Group C had a similar proportion of cesarean section with Group A,but a significantly higher proportion than Group B(16.5%vs.9.9%vs.6.3%,P=0.045),while other basic parameters were not statistically different among the three groups(P>0.05).The implantation rate(58.8%vs.48.0%vs.34.1%,P<0.001)and clinical pregnancy rate(75.5%vs.63.0%vs.50.6%,P<0.001)in Group B were significantly higher than those in Group A and Group C.The ongoing pregnancy rate in Group B was similar to that in Group A,but significantly higher than that in Group C(67.3%vs.57.1%vs.46.8%,P=0.008).There was no significant difference in early abortion rate among the three groups(P=0.869).After multiple Logistic regression analysis,there was no significant difference in the ongoing pregnancy rate among the three groups(P>0.05).Conclusions:The FET pregnancy outcomes on the first menstrual cycle after polypectomy are comparable to that of delayed treatment.To alleviate the psychological burden on patients and expedite the time to pregnancy,it is recommended to schedule FET treatment after the first menstrual cycle following polypectomy.