Pope Christian S, Cook Elizabeth K D, Arny Margaret, Novak Amy, Grow Daniel R
Department of Obstetrics and Gynecology, Baystate Medical Center, Baystate Medical Center, Springfield, Massachusetts 01199, USA.
Fertil Steril. 2004 Jan;81(1):51-8. doi: 10.1016/j.fertnstert.2003.05.030.
To investigate the influence of transfer distance from the fundus (TDF) on clinical pregnancy rate (PR) and ectopic pregnancy rate.
Retrospective cohort. Between January 2000 and December 2001, 699 ultrasound (US)-guided embryo transfers were conducted. Mock transfer was performed to measure uterine cavity depth 1 month before treatment. Cavity depth was measured by abdominal US before the transfer, from the vaginal stripe to the fundus. Transfers were performed with a Wallace embryo transfer catheter (Cooper Surgical, Shelton, CT) using US and physician's judgment of cavity depth. Transfer distance from the fundus was calculated by subtracting the depth of catheter insertion from the cavity depth, as determined by US or by mock transfer. Statistical analyses were performed by building a multivariable logistic regression model to calculate odds ratios and 95% confidence intervals (CI).
Women aged 23 to 43 years who are in a university-affiliated, community-based IVF program in Springfield, Massachusetts.
PATIENT(S): All patients enrolled in IVF program undergoing embryo transfer.
INTERVENTION(S): No patient received any additional procedure or intervention. All of the measurements obtained with the embryo catheter and the transvaginal ultrasound were part of the program's protocol for the embryo transfer.
MAIN OUTCOME MEASURE(S): Odds ratio examining relationship between embryo transfer depth and PR.Clinical, implantation, and ectopic PR were 37%, 20%, and 2.1%. Cavity depth by US differed from cavity depth by mock by at least 10 mm in >30% of cases. The TDF by US was highly predictive of PR; TDF by mock was not predictive of PR. Increasing the TDF by US resulted in significantly increased PR as well as lower ectopic rates. Using regression analysis, the odds ratio for TDF by US was 1.11 (95% CI: 1.07-1.14). This suggests that for every additional millimeter embryos are deposited away from the fundus, the odds of clinical pregnancy increased by 11%.
CONCLUSION(S): After controlling for potential confounders, the clinical PR is significantly influenced by the transfer distance from the fundus. Cavity depth by US is clinically useful to determine the depth beyond which catheter insertion should not occur.
探讨距宫底的移植距离（TDF）对临床妊娠率（PR）和异位妊娠率的影响。
回顾性队列研究。2000年1月至2001年12月期间，共进行了699次超声（US）引导下的胚胎移植。在治疗前1个月进行模拟移植以测量子宫腔深度。移植前通过腹部超声从阴道条纹至宫底测量腔深度。使用Wallace胚胎移植导管（Cooper Surgical，Shelton，CT）并结合超声及医生对腔深度的判断进行移植。距宫底的移植距离通过用超声或模拟移植确定的腔深度减去导管插入深度来计算。通过构建多变量逻辑回归模型进行统计分析，以计算比值比和95%置信区间（CI）。
马萨诸塞州斯普林菲尔德市一个大学附属的社区体外受精项目中年龄在23至43岁的女性。
所有参与体外受精项目并接受胚胎移植的患者。
无患者接受任何额外的程序或干预。用胚胎导管和经阴道超声获得的所有测量值都是该项目胚胎移植方案的一部分。
检验胚胎移植深度与PR之间关系的比值比。临床、着床和异位PR分别为37%、20%和2.1%。在超过30%的病例中，超声测量的腔深度与模拟测量的腔深度相差至少10毫米。超声测量的TDF对PR具有高度预测性；模拟测量的TDF对PR无预测性。增加超声测量的TDF会导致PR显著增加以及异位率降低。通过回归分析，超声测量的TDF的比值比为1.11（95%CI：1.07 - 1.14）。这表明胚胎距宫底每多植入1毫米，临床妊娠的几率增加11%。
在控制潜在混杂因素后，临床PR受距宫底的移植距离显著影响。超声测量的腔深度在临床上有助于确定不应进行导管插入的深度范围。
