Ding H F, Tian L
Center of Reproductive Medicine, Peking University People's Hospital, Beijing 100044, China.
Zhonghua Fu Chan Ke Za Zhi. 2018 Nov 25;53(11):742-748. doi: 10.3760/cma.j.issn.0529-567x.2018.11.003.
To explore the relationship between endometrial thickness and clinical pregnancy outcomes in frozen-thawed embryo transfer cycles. A prospective study was performed for 1 475 frozen-thawed embryo transfer cycles at Peking University People's Hospital from January 2014 to December 2015. The patients were divided into different groups according to endometrial thickness of ovulation day in natural menstrual cycles or endometrial transformation day in hormone replacement cycles;patients with thin endometrium were enndometrial thickness ≤6 mm. Then the clinical pregnancy outcomes including clinical pregnancy rate, embryo implantation rate, abortion rate, multiple birth rate and live birth rate were analyzed. In all, 1 475 frozen-thawed embryo transfer cycles were analyzed. The mean age of patients was (32.5±3.9) years old and mean endometrial thickness was (9.2±1.9) mm, and mean number of embryos was 2.03±0.37. The study included 518 (35.1%) natural menstrual cycles and 957 (64.9%) hormone replacement cycles. The number of embryo-transfer cycles and blastocyst-transfer cycles were respectively 700 (47.5%) and 775 (52.5%) . The overall clinical pregnancy rate, embryo implantation rate, abortion rate, multiple birth rate and live birth rate were 54.4%, 35.7%, 23.3%, 24.1%, 43.9%, respectively. The ectopic pregnancy rate in the study was 0.6%. In patients with thin endometrium,there were significant differences in 2 pronucleus count (0.016) and available embryo count (0.024) between cycles that resulted in pregnancy and those that did not;besides, the use of sildenafil and growth hormone did not improve pregnancy outcomes in patients with thin endometrium (0.183, 0.400) . The clinical pregnancy rate, embryo implantation rate and live birth rate of embryo-transfer and blastocyst-transfer were similar in patients with thin endometrium (all 0.05) . Patients with thin endometrium have poor pregnancy outcomes. The clinical pregnancy rate, embryo implantation rate and live birth rate of embryo-transfer and blastocyst-transfer are similar in patients with thin endometrium. Compared thin endometrium and non-thin endometrium patients, the clinical pregnancy rate and live birth rate of blastocysts have more substantial decline than those of embryos. Improving the quality of embryo could improve the pregnancy outcome of patients with thin endometrium. Sildenafil and growth hormone could not improve pregnancy outcome in patients with thin endometrium.
探讨冻融胚胎移植周期中子宫内膜厚度与临床妊娠结局之间的关系。对2014年1月至2015年12月北京大学人民医院的1475个冻融胚胎移植周期进行了一项前瞻性研究。根据自然月经周期排卵日或激素替代周期子宫内膜转化日的子宫内膜厚度将患者分为不同组;子宫内膜薄的患者为子宫内膜厚度≤6mm。然后分析临床妊娠结局,包括临床妊娠率、胚胎着床率、流产率、多胎出生率和活产率。共分析了1475个冻融胚胎移植周期。患者的平均年龄为(32.5±3.9)岁,平均子宫内膜厚度为(9.2±1.9)mm,平均胚胎数为2.03±0.37。该研究包括518个(35.1%)自然月经周期和957个(64.9%)激素替代周期。胚胎移植周期和囊胚移植周期的数量分别为700个(47.5%)和775个(52.5%)。总体临床妊娠率、胚胎着床率、流产率、多胎出生率和活产率分别为54.4%、35.7%、23.3%、24.1%、43.9%。该研究中的异位妊娠率为0.6%。在子宫内膜薄的患者中,妊娠周期和未妊娠周期之间的原核计数(0.016)和可用胚胎计数(0.024)存在显著差异;此外,西地那非和生长激素并未改善子宫内膜薄的患者的妊娠结局(0.183,0.400)。子宫内膜薄的患者中胚胎移植和囊胚移植的临床妊娠率、胚胎着床率和活产率相似(均P>0.05)。子宫内膜薄的患者妊娠结局较差。子宫内膜薄的患者中胚胎移植和囊胚移植的临床妊娠率、胚胎着床率和活产率相似。与子宫内膜不薄的患者相比,囊胚的临床妊娠率和活产率的下降幅度比胚胎的更大。提高胚胎质量可以改善子宫内膜薄的患者的妊娠结局。西地那非和生长激素不能改善子宫内膜薄的患者的妊娠结局。