Lesny P, Killick S R, Tetlow R L, Manton D J, Robinson J, Maguiness S D
Academic Department of Obstetrics and Gynaecology, University of Hull and The Hull IVF Unit, Princess Royal Hospital, Hull, UK.
Hum Reprod. 1999 Jun;14(6):1593-8. doi: 10.1093/humrep/14.6.1593.
This study was designed to establish if ultrasound could detect differences in uterine zonal anatomy between conception and non-conception in-vitro fertilization (IVF)/embryo transfer cycles. A transvaginal ultrasound scan was performed on the day of down regulation (D0), on day 8 of ovulation induction (D8), on the day of human chorionic gonadotrophin (HCG) injection, at the time of oocyte retrieval, and at embryo transfer. Thicknesses of endometrium, junctional zone, myometrium and full thickness of the uterus were recorded for every patient and comparisons made at all the assessment points. Differences between measurements on D0 and all other measurements (temporal changes) and between every subsequent measurement (dynamic changes) were also compared. There were no statistically significant differences in endometrial thickness between pregnant and non-pregnant groups at any time. The diameter of the uterus increased during therapy and was significantly greater in the pregnant subset at the time of HCG injection, oocyte retrieval and embryo transfer (P < 0.02, 0.03 and 0.02 respectively). The myometrium was significantly thicker in the pregnant group on D0, on D8 and at HCG administration (P < 0.03, 0.004 and 0.02). There was a decrease in junctional zone thickness in both groups during the first week of ovulation induction, and on D8 the junctional zone in pregnant patients was significantly thinner (P < 0.04). The junctional zone became significantly thicker at embryo transfer in the pregnant group (P < 0.01). This was confirmed by significant temporal and dynamic changes at the time of oocyte retrieval and embryo transfer (P < 0.01, 0.0001 and P < 0.05, 0.01 respectively). In the patients who did not conceive, changes in the junctional zone were less pronounced. In conclusion, it was not possible to predict the likelihood of pregnancy from endometrial thickness at any time during the IVF cycle, but changes occurred in other uterine layers that were more pronounced in conception cycles. The responsiveness of the junctional zone seems to be associated with implantation, and its measurements at the time of downregulation and embryo transfer can be used to predict treatment outcome.
本研究旨在确定超声能否检测出体外受精（IVF）/胚胎移植周期中受孕与未受孕情况下子宫分层解剖结构的差异。在降调节日（D0）、促排卵第8日（D8）、注射人绒毛膜促性腺激素（HCG）当日、取卵时以及胚胎移植时进行经阴道超声扫描。记录每位患者的子宫内膜、交界区、肌层厚度及子宫全层厚度，并在所有评估点进行比较。还比较了D0时的测量值与所有其他测量值之间的差异（时间变化）以及每一次后续测量值之间的差异（动态变化）。在任何时候，妊娠组和未妊娠组的子宫内膜厚度均无统计学显著差异。治疗期间子宫直径增大，在注射HCG、取卵和胚胎移植时，妊娠亚组的子宫直径显著更大（分别为P < 0.02、0.03和0.02）。在D0、D8和注射HCG时，妊娠组的肌层明显更厚（P < 0.03、0.004和0.02）。在促排卵的第一周，两组的交界区厚度均下降，且在D8时，妊娠患者的交界区明显更薄（P < 0.04）。在妊娠组胚胎移植时，交界区明显增厚（P < 0.01）。在取卵和胚胎移植时的显著时间和动态变化证实了这一点（分别为P < 0.01、0.0001和P < 0.05、0.01）。在未受孕的患者中，交界区的变化不太明显。总之，在IVF周期的任何时候，都无法根据子宫内膜厚度预测妊娠可能性，但其他子宫层会发生变化，且在受孕周期中更为明显。交界区的反应性似乎与着床有关，其在降调节和胚胎移植时的测量值可用于预测治疗结果。
