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目的：本研究旨在探讨不同促排方案下子宫内膜厚度（endometrial thickness,EMT）与妊娠结局的相关性，并寻找最佳临床妊娠率和活产率的EMT范围。方法：回顾性分析2017年08月～2022年12月在海南省妇女儿童医学中心生殖中心接受体外受精/卵胞浆内单精子显微注射（IVF/ICSI）治疗年龄<38岁不孕症患者的临床资料，共纳入1 844个新鲜胚胎移植周期。根据促排方案将鲜胚移植周期分为激动剂长方案组（A组）708个周期和拮抗剂方案组（B组）1 136个周期，A、B组分别按HCG日EMT分为3个亚组：EMT<8.0 mm、8.0 mm≤EMT≤12.0 mm、EMT>12.0 mm，收集各组基础指标及临床结局相关数据，通过单因素分析、多因素logistic回归分析、平滑曲线拟合及阈值效应分析探讨不同促排方案下EMT与新鲜胚胎移植妊娠结局的相关性。结果：A组、B组中不同EMT亚组的临床妊娠率、活产率差异有统计学意义（P<0.05），流产率、异位妊娠率、平均单胎分娩孕周和平均单胎出生体重组间差异无统计学意义（P>0.05）。多因素logistic回归分析结果显示A组、B组中EMT的增加与临床妊娠率、活产率的增加显著相关（P<0.05）。结合两组平滑曲线拟合图与阈值效应分析结果发现，当EMT<10.2 mm时，两组的临床妊娠率随着EMT的增加而显著增加（a OR=1.36;95%CI=1.11,1.67,P=0.003）、（a OR=1.22;95%CI=1.06,1.41,P=0.006）；当EMT≥10.2 mm时，两组的临床妊娠率随着EMT增加变化平稳。而两组的活产率均随着EMT的增加而增加。结论：激动剂长方案和拮抗剂方案新鲜胚胎移植周期中，临床妊娠率随着EMT的增加而显著增加，当EMT达到10.2 mm后临床妊娠率趋于平稳。活产率随着EMT的增加而增加。
Abstract：Objective: To investigate the correlation between endometrial thickness(EMT) and pregnancy outcomes under different protocols of ovulation promotion and to find the range of EMT for optimal clinical pregnancy and live birth rates. Methods: Clinical data of infertility patients aged <38 years who underwent in vitro fertilization/intracytoplasmic monosperm microinjection(IVF/ICSI) for treatment of infertility at the Reproductive Center of Hainan Provincial Women′s and Children′s Medical Center from August 2017 to December 2022 were retrospectively analyzed, and a total of 1 844 fresh embryo transfer cycles were included. The fresh embryo transfer cycles were divided into 708 cycles in the agonist long protocol group(Group A) and 1 136 cycles in the antagonist protocol group(Group B) according to the protocol of ovulation promotion, and Groups A and B were divided into three subgroups according to the EMT on the day of HCG, respectively: EMT < 8.0 mm, 8.0 mm ≤ EMT ≤ 12.0 mm, EMT>12.0 mm. Data related to basic indexes and clinical outcomes were collected from each group, and the correlation between EMT and pregnancy outcomes of fresh embryo transfer under different regimens of ovulation promotion was explored by one-way analysis, multifactorial logistic regression analysis, smoothed curve fitting and threshold effect analysis. Results: The differences in clinical pregnancy rate and live birth rate among different EMT subgroups in Groups A and B were statistically significant(P<0.05), and the differences among miscarriage rate, ectopic pregnancy rate, mean gestational week of delivery of a single fetus, and mean weight of a single birth group were not statistically significant(P>0.05). The results of multifactorial logistic regression analysis showed that the increase in EMT was significantly correlated with the increase in clinical pregnancy rate and live birth rate in Groups A and B(P<0.05). Combining the smoothed curve fit plots of the two groups with the results of the threshold effect analysis, it was found that when the EMT was <10.2 mm, the clinical pregnancy rate in the two groups increased significantly with the increase of EMT(a OR=1.36; 95% CI=1.11, 1.67, P=0.003),(a OR=1.22; 95% CI=1.06, 1.41, P=0.006); when the EMT≥10.2 mm, the clinical pregnancy rate in both groups changed smoothly with increasing EMT. And the live birth rate increased with increasing EMT in both groups.Conclusion: Clinical pregnancy rates in the agonist long protocol group and antagonist protocol group in fresh embryo transfer cycles increased significantly with the thickening of the EMT, and the clinical pregnancy rates leveled off when the EMT reached 10.2 mm. The live birth rate increased with the thickening of the EMT.
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基本信息:
DOI：10.13210/j.cnki.jhmu.20241010.003
中图分类号:R714.8
引用信息:
[1]吴春娇,吴亚妹,马宁,等.不同促排方案的新鲜胚胎移植周期中子宫内膜厚度与妊娠结局相关性分析[J].海南医科大学学报,2025,31(17):1344-1352.DOI:10.13210/j.cnki.jhmu.20241010.003.
基金信息:
国家自然科学基金资助项目(82260304)~~
2024-10-11
2024-10-11
2024-10-11