Detti Laura, Yelian Frank D, Kruger Michael L, Diamond Michael P, Puscheck Elizabeth E
Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Wayne State University School of Medicine, Detroit, MI 48201 USA.
J Ultrasound Med. 2008 Nov;27(11):1591-6. doi: 10.7863/jum.2008.27.11.1591.
The purpose of this study was to evaluate whether the dynamics of endometrial stripe thickness during gonadotropin-releasing hormone (GnRH) antagonist pituitary downregulation in in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) cycles are related to implantation and pregnancy outcomes.
This retrospective cohort study evaluated 115 conventional IVF/ICSI cycles. All patients underwent ovarian stimulation with gonadotropins and the GnRH antagonist ganirelix acetate. The endometrial stripe was measured transvaginally daily from the day of initial GnRH antagonist administration to the day of the human chorionic gonadotropin (hCG) trigger and then transabdominally on the day of embryo transfer. We created 5 categories (0-4) of endometrial thickness variation, considering significant a daily variation of 1.5 mm. Our aim was to predict whether the endometrial thickness dynamics or morphologic characteristics were related to the duration of ovarian stimulation, duration of ganirelix use, or estradiol levels during ovarian stimulation and whether they would influence implantation and pregnancy rates.
No relationship was found between the duration of ovarian stimulation, duration of ganirelix use, and estradiol level (expressed as the area under the curve), and endometrial thickness dynamics or morphologic characteristics. Despite a thinner endometrial thickness in 37% of the cycles on the day of the hCG trigger compared with the beginning of GnRH antagonist stimulation, there was no correlation between endometrial dynamics and pregnancy outcomes. There was, instead, a positive relationship between a trilaminar endometrial morphologic pattern with a positive pregnancy test result, successful implantation, and ongoing pregnancy (P < .05).
Despite a net decrease in thickness in almost 50% of cases, endometrial dynamics did not correlate with pregnancy outcomes. Conversely, a trilaminar endometrial morphologic pattern on the day of embryo transfer was positively related to pregnancy outcomes.
本研究旨在评估在体外受精（IVF）/卵胞浆内单精子注射（ICSI）周期中，促性腺激素释放激素（GnRH）拮抗剂垂体降调节期间子宫内膜厚度的动态变化是否与着床及妊娠结局相关。
这项回顾性队列研究评估了115个常规IVF/ICSI周期。所有患者均接受促性腺激素及GnRH拮抗剂醋酸加尼瑞克进行卵巢刺激。从首次给予GnRH拮抗剂当天至人绒毛膜促性腺激素（hCG）触发日，每天经阴道测量子宫内膜厚度，然后在胚胎移植日经腹部测量。考虑到每日显著变化1.5 mm，我们将子宫内膜厚度变化分为5类（0 - 4）。我们的目的是预测子宫内膜厚度动态变化或形态学特征是否与卵巢刺激持续时间、加尼瑞克使用时间或卵巢刺激期间的雌二醇水平相关，以及它们是否会影响着床率和妊娠率。
未发现卵巢刺激持续时间、加尼瑞克使用时间和雌二醇水平（以曲线下面积表示）与子宫内膜厚度动态变化或形态学特征之间存在关联。尽管与GnRH拮抗剂刺激开始时相比，37%的周期在hCG触发日的子宫内膜厚度更薄，但子宫内膜动态变化与妊娠结局之间无相关性。相反，妊娠试验结果为阳性、成功着床及持续妊娠的患者，其子宫内膜呈三层形态学模式之间存在正相关关系（P <.05）。
尽管近50%的病例子宫内膜厚度有净减少，但子宫内膜动态变化与妊娠结局无关。相反，胚胎移植日的子宫内膜三层形态学模式与妊娠结局呈正相关。
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