Coelho Neto M A, Martins W P, Lima M L S, Barbosa M A P, Nastri C O, Ferriani R A, Navarro P A
Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil.
Ultrasound Obstet Gynecol. 2015 Oct;46(4):501-5. doi: 10.1002/uog.14884. Epub 2015 Aug 31.
To examine whether endometrial thickness and the presence of endometrioma are independent predictors of clinical pregnancy rate or simply associated with poor ovarian response (POR).
This was a retrospective cohort study assessing the first cycle of all women undergoing in-vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) in a university hospital in Brazil between January 2011 and December 2012. Only the first cycle of each woman within the study period was considered. Women over 40 years of age and those who used clomiphene citrate during controlled ovarian stimulation (COS) or did not undergo embryo transfer were excluded from analysis. POR was defined as ≤ three oocytes retrieved and a thin endometrium was defined as endometrial thickness ≤ 7.0 mm on the day of human chorionic gonadotropin (hCG) administration. We performed a multiple regression analysis to identify which of the following parameters were independent predictors of clinical pregnancy: age, number of oocytes retrieved, endometrial thickness or the presence of endometrioma.
Within the study period, 787 women began COS, but 270 were excluded from analysis. Among the 517 women analyzed, those who achieved pregnancy were younger and yielded more oocytes. The proportion of POR was higher in women with a thin endometrium (17/57 (29.8%) vs 80/460 (17.4%); P = 0.03) and in women with endometrioma (15/39 (38.5%) vs 82/478 (17.2%); P = 0.002). The results of regression analysis showed that only age and the number of oocytes retrieved were independent predictors of pregnancy. Additionally, we observed higher clinical pregnancy rates in women with a thin endometrium from whom ≥ seven oocytes were retrieved (11/25 (44.0%)) compared to women with normal endometrial thickness (99/241 (41.1%)). Considering only women from whom ≥ four oocytes were retrieved, we observed reasonable pregnancy rates in those with a thin endometrium (14/40 (35.0%)) and in those with endometrioma (9/24 (37.5%)).
Both a thin endometrium and the presence of endometrioma are associated with POR but are not important independent predictors of clinical pregnancy. Good pregnancy rates can be observed when these conditions are present in women with a good ovarian response.
探讨子宫内膜厚度和子宫内膜瘤的存在是否是临床妊娠率的独立预测因素，还是仅仅与卵巢低反应（POR）相关。
这是一项回顾性队列研究，评估了2011年1月至2012年12月在巴西一家大学医院接受体外受精（IVF）或卵胞浆内单精子注射（ICSI）的所有女性的第一个周期。仅考虑研究期间每位女性的第一个周期。年龄超过40岁以及在控制性卵巢刺激（COS）期间使用枸橼酸氯米芬或未进行胚胎移植的女性被排除在分析之外。POR定义为回收的卵母细胞≤3个，薄子宫内膜定义为在人绒毛膜促性腺激素（hCG）给药当天子宫内膜厚度≤7.0mm。我们进行了多元回归分析，以确定以下哪些参数是临床妊娠的独立预测因素：年龄、回收的卵母细胞数量、子宫内膜厚度或子宫内膜瘤的存在。
在研究期间，787名女性开始进行COS，但270名被排除在分析之外。在分析的517名女性中，成功妊娠的女性更年轻且回收的卵母细胞更多。薄子宫内膜女性（17/57（29.8%）对80/460（17.4%）；P = 0.03）和有子宫内膜瘤的女性（15/39（38.5%）对82/478（17.2%）；P = 0.002）中POR的比例更高。回归分析结果表明，只有年龄和回收的卵母细胞数量是妊娠的独立预测因素。此外，我们观察到回收≥7个卵母细胞的薄子宫内膜女性的临床妊娠率（11/25（44.0%））高于子宫内膜厚度正常的女性（99/241（41.1%））。仅考虑回收≥4个卵母细胞的女性，我们观察到薄子宫内膜女性（14/40（35.0%））和有子宫内膜瘤的女性（9/24（37.5%））的妊娠率合理。
薄子宫内膜和子宫内膜瘤的存在均与POR相关，但不是临床妊娠的重要独立预测因素。当卵巢反应良好的女性存在这些情况时，可以观察到良好的妊娠率。
