School of Medicine, Shandong University, Jinan, Shandong 250012, China.
Department of Gynecology, Reproductive Hospital Affiliated to Shandong University, Jinan, Shandong 250012, China.
Chin Med J (Engl). 2019 Oct 5;132(19):2333-2339. doi: 10.1097/CM9.0000000000000456.
Very few studies have been conducted regarding the optimal time interval between hysteroscopic adhesiolysis and the embryo transfer (ET). Investigation of this optimal time may be helpful for assisted reproductive technology. Therefore, we investigated effects of the interval between hysteroscopic adhesiolysis and ET upon in vitro fertilization (IVF) cycle outcomes.
Patients were recruited between January 2014 and September 2017 at the Reproductive Hospital Affiliated to Shandong University. Patients who were diagnosed with intra-uterine adhesion (IUA) and underwent hysteroscopic adhesiolysis before fresh IVF-ET or intra-cytoplasmic sperm injection cycles were classified into three groups according to the interval between hysteroscopic adhesiolysis and ET: less than 90 days (Group 1), 90 to 180 days (Group 2), and greater than 180 days (Group 3). Baseline characteristics, controlled ovarian stimulation (COS) response, and pregnancy outcomes after ET were compared. Analysis of variance or non-parametric tests were used to test numerical data. The Pearson's Chi-squared test was used to test categorical data.
A total of 312 patients were recruited as follows: 112 in Group 1, 137 in Group 2, and 63 in Group 3. There were no differences in baseline and COS characteristics among the three groups. The live-birth rate in Group 2 (40.1%) was significantly higher than that in Group 1 (17.9%; χ = 14.545, P < 0.001). There were no significant differences in the rates of biochemical, ongoing, and clinical pregnancy, and biochemical and clinical pregnancy abortion, as well as stillbirth among the groups. In the mild IUA patients, the live-birth rate was significantly higher in Group 2 (42.6%) compared with Group 1 (22%; χ = 8.413, P = 0.004). In the moderate IUA patients, Group 2 (35.7%) had a higher frequency of live births than Group 1 (6.7%; χ = 8.187, P = 0.004).
The optimal waiting period for fresh ET after hysteroscopic adhesiolysis was 90 to 180 days in the current study.
关于宫腔镜粘连松解术与胚胎移植（ET）之间的最佳时间间隔，目前研究甚少。对这一最佳时间的研究可能有助于辅助生殖技术。因此，我们研究了宫腔镜粘连松解术与 ET 之间的间隔时间对体外受精（IVF）周期结局的影响。
本研究于 2014 年 1 月至 2017 年 9 月在山东大学附属生殖医院进行。将诊断为宫腔粘连（IUA）并在新鲜 IVF-ET 或卵胞浆内单精子注射周期前行宫腔镜粘连松解术的患者根据宫腔镜粘连松解术与 ET 之间的间隔时间分为三组：小于 90 天（组 1）、90-180 天（组 2）和大于 180 天（组 3）。比较 ET 后患者的基线特征、控制性卵巢刺激（COS）反应和妊娠结局。数值数据采用方差分析或非参数检验进行检验。分类数据采用 Pearson 卡方检验进行检验。
共纳入 312 例患者：组 1 112 例，组 2 137 例，组 3 63 例。三组患者的基线和 COS 特征无差异。组 2（40.1%）的活产率明显高于组 1（17.9%；χ²=14.545，P<0.001）。三组间生化妊娠、持续妊娠和临床妊娠率以及生化妊娠流产率和临床妊娠流产率、死产率均无差异。在轻度 IUA 患者中，组 2（42.6%）的活产率明显高于组 1（22%；χ²=8.413，P=0.004）。在中度 IUA 患者中，组 2（35.7%）的活产率高于组 1（6.7%；χ²=8.187，P=0.004）。
本研究中，宫腔镜粘连松解术后新鲜 ET 的最佳等待时间为 90-180 天。
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