Wang Xuechun, Yi Jingsong, Xie Xi, Du Shengrong, Li Liying, Zheng Xiuqiong
Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China.
Assisted Reproductive Technologies Research Institute, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian 350001, P.R. China.
Exp Ther Med. 2019 Nov;18(5):3675-3680. doi: 10.3892/etm.2019.7935. Epub 2019 Aug 23.
This study aimed to investigate the clinical factors affecting pregnancy rates following the surgical removal of intrauterine adhesions (IUAs) and subsequent fertilization and embryo transfer (IVF-ET). We retrospectively evaluated case data from patients who had undergone hysteroscopic surgery to remove varying degrees of IUAs and who had subsequently received assisted reproductive treatments with IVF-ET (in all 140 cycles) at our hospital between January, 2011 and January, 2015. The patient data were divided into either the pregnancy or non-pregnancy groups based on the pregnancy outcomes, and a number of clinicopathological variables were compared these two groups, such as age, infertility (type and duration), the number of prior surgical treatments for and severity of IUAs, the baseline follicle-stimulating hormone/luteinizing hormone (FSH/LH) ratio and estradiol level, endometrial thickness on the day of human chorionic gonadotropin (hCG) administration, etc. We selected the variables with statistically significant differences to generate multivariate logistic regression and linear correlation analyses. We found that i) the mean endometrial thickness on the day of hCG administration was greater in the pregnancy group, and that the average gestational age was younger than that in the non-pregnancy group. The different age groups had significantly different pregnancy rates. The mean baseline FSH/LH ratio of the women in the pregnancy group was lower than that in the women in the non-pregnancy group. The number of embryos transferred in the pregnancy group was higher than that in the non-pregnancy group. However, the other variables exhibited similar values between these two groups. ii) Our multivariate logistic regression analyses revealed that age and endometrial thickness on the day of hCG administration had significant effects on the pregnancy outcome. The baseline FSH/LH ratio and the number of embryos transferred were similar between the groups. On the whole, age and endometrial thickness on the day of hCG administration are the most important predictors of pregnancy outcome in the patients undergoing IVF-ET following the surgical removal of IUAs. Importantly however, the identification of effective methods with which to improve the endometrial thickness and the ovarian response in patients with diminished ovarian reserves warrants further investigation in future research.
本研究旨在探讨影响宫腔粘连（IUAs）手术切除及后续体外受精 - 胚胎移植（IVF - ET）后妊娠率的临床因素。我们回顾性评估了2011年1月至2015年1月期间在我院接受宫腔镜手术切除不同程度IUAs且随后接受IVF - ET辅助生殖治疗（共140个周期）患者的病例数据。根据妊娠结局将患者数据分为妊娠组和非妊娠组，并比较两组的一些临床病理变量，如年龄、不孕情况（类型和病程）、既往IUAs手术治疗次数和严重程度、基础促卵泡激素/促黄体生成素（FSH/LH）比值和雌二醇水平、人绒毛膜促性腺激素（hCG）给药当天的子宫内膜厚度等。我们选择具有统计学显著差异的变量进行多因素逻辑回归和线性相关分析。我们发现：i）hCG给药当天妊娠组的平均子宫内膜厚度更大，且平均孕周比非妊娠组年轻。不同年龄组的妊娠率有显著差异。妊娠组女性的基础FSH/LH比值低于非妊娠组女性。妊娠组移植的胚胎数量高于非妊娠组。然而，其他变量在两组之间表现出相似的值。ii）我们的多因素逻辑回归分析显示，hCG给药当天的年龄和子宫内膜厚度对妊娠结局有显著影响。两组之间的基础FSH/LH比值和移植胚胎数量相似。总体而言，hCG给药当天的年龄和子宫内膜厚度是IUAs手术切除后接受IVF - ET患者妊娠结局的最重要预测因素。然而，重要的是，确定改善卵巢储备功能减退患者子宫内膜厚度和卵巢反应有效方法的研究在未来研究中仍有待进一步探索。
