1 Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, MD, USA.
2 Walter Reed National Military Medical Center, Bethesda, MD, USA.
Reprod Sci. 2017 May;24(5):726-730. doi: 10.1177/1933719116667607. Epub 2016 Sep 21.
The technique used for embryo transfer (ET) can affect implantation. Prior research that evaluated the effect of postprocedural blood of the transfer catheter tip have yielded mixed results, and it is unclear whether this is actually a marker of difficulty of the transfer. Our objective was to estimate the effect of blood at the time of ET and the difficulty of ET on live birth rates (LBR). This retrospective cohort study utilized generalized estimating equations (GEEs) with nesting for repeated cycles for all analyses. Univariate modeling was performed and a final multivariate (adjusted) GEE model accounted for all significant confounders. Embryo transfers were subjectively graded (easy, medium, or hard) by a physician at the time of transfer. The presence of blood at ET was associated with more difficult ETs, retained embryos, and presence of mucous in the catheter. In the univariate analysis, ET with blood was not associated with live birth, while the degree of difficulty for ET had a negative impact on LBR. In the final multivariate GEE model, which accounts for repeated cycles from a patient, the only factors associated with an increased LBR were the degree of difficulty of the ET, female age, and blastocyst transfer. After controlling for confounding variables, the presence of blood in the transfer catheter was not associated with the likelihood of pregnancy and thus was not an independent predictor of cycle outcome. This indicates that the difficulty of the transfer itself was a strong negative predictor of pregnancy.
胚胎移植 (ET) 中使用的技术会影响着床。先前评估转移导管尖端术后血液对移植影响的研究结果喜忧参半，并且尚不清楚这是否实际上是移植难度的标志。我们的目的是评估 ET 时血液以及 ET 难度对活产率 (LBR) 的影响。这项回顾性队列研究对所有分析均使用了广义估计方程 (GEE) 进行了嵌套的重复周期。进行了单变量建模，最终的多变量（调整）GEE 模型考虑了所有显著的混杂因素。胚胎移植时，医生会对胚胎移植进行主观分级（容易、中等或困难）。ET 时存在血液与更困难的 ET、保留胚胎以及导管中存在黏液有关。在单变量分析中，ET 时存在血液与活产无关，而 ET 的难度对 LBR 有负面影响。在最终的多变量 GEE 模型中，该模型考虑了来自患者的重复周期，唯一与 LBR 增加相关的因素是 ET 的难度、女性年龄和囊胚转移。在控制混杂变量后，转移导管中存在血液与妊娠的可能性无关，因此不是周期结局的独立预测因素。这表明转移本身的难度是妊娠的强烈负预测因素。
