子宫内膜厚度对 IVF/ICSI 后新鲜周期妇女妊娠、母婴及围产结局的影响：系统评价和荟萃分析。
The Effect of Endometrial Thickness on Pregnancy, Maternal, and Perinatal Outcomes of Women in Fresh Cycles After IVF/ICSI: A Systematic Review and Meta-Analysis.
机构信息
Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Reproductive Medicine Center, The Affiliated Drum Tower Hospital of Nanjing University Medical College, Nanjing, China.
出版信息
Front Endocrinol (Lausanne). 2022 Feb 11;12:814648. doi: 10.3389/fendo.2021.814648. eCollection 2021.
BACKGROUND
Thin endometrium on ovulation triggering day is associated with impaired pregnancy outcomes in women after fertilization/intracytoplasmic sperm injection (IVF/ICSI), but the role of thick endometrium on pregnancy outcomes remains controversial. Moreover, there has been insufficient evidence currently to analyze the influence of endometrial thickness (EMT) on obstetric complications and perinatal outcomes. Thus, we performed this meta-analysis to evaluate the effect of EMT on pregnancy, maternal, and perinatal outcomes in an enlarged sample size.
METHODS
The databases Pubmed, Embase, Cochrane Libraries, and Web of Science were searched for English articles evaluating the correlation between EMT and pregnancy, maternal, or perinatal outcomes in women who underwent IVF/ICSI. We included studies that depicted a clear definition of outcomes and EMT grouping on ovulation triggering day. The EMT effect was analyzed in fresh cycle. Qualities of studies were assessed by the Newcastle-Ottawa Scale (NOS). Odds ratios (ORs) and weighted mean difference (WMD) with 95% confidence intervals (CIs) were calculated for analyzing dichotomous and continuous outcomes respectively, under a fixed or random effect model.
RESULTS
A total of 22 pieces of literature were included for the final meta-analysis. A decreased trend towards pregnancy outcomes was observed, such as live birth rate (LBR), clinical pregnancy rate (CPR), and implantation rate (IR) in the thin endometrium groups (EMT <7 mm). In contrast, thick endometrium (EMT >14 mm) had no effect on pregnancy outcomes compared to medium EMT groups (EMT 7-14 mm). Moreover, thin endometrium (EMT <7.5 mm) enhanced the incidence of hypertensive disorders of pregnancy (HDP) and small-for-gestational-age (SGA) infants, and decreased the birthweight (BW) of babies.
CONCLUSIONS
Our studies indicated that thin endometrium not only had detrimental effect on pregnancy outcomes, but also increased the risk of HDP in women and SGA of babies, or decreased BW of babies. The thick endometrium does not have an adverse effect on IVF outcomes. Therefore, patients need to be informed on possible obstetric complications and perinatal outcomes caused by thin endometrium and are encouraged to actively cooperate with perinatal care.
SYSTEMATIC REVIEW REGISTRATION
(https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=242637), identifier CRD42021242637.
背景
在接受体外受精/卵胞浆内单精子注射（IVF/ICSI）后，排卵触发日的薄子宫内膜与妊娠结局受损有关，但厚子宫内膜对妊娠结局的影响仍存在争议。此外，目前还没有足够的证据来分析子宫内膜厚度（EMT）对产科并发症和围产儿结局的影响。因此，我们进行了这项荟萃分析，以在更大的样本量中评估 EMT 对妊娠、产妇和围产儿结局的影响。
方法
在 Pubmed、Embase、Cochrane 图书馆和 Web of Science 数据库中搜索评估 EMT 与接受 IVF/ICSI 的女性妊娠、产妇或围产儿结局之间相关性的英文文章。我们纳入了明确定义结局和排卵触发日 EMT 分组的研究。在新鲜周期中分析 EMT 效应。使用纽卡斯尔-渥太华量表（NOS）评估研究质量。采用固定或随机效应模型，分别计算二分类和连续结局的优势比（OR）和加权均数差（WMD）及 95%置信区间（CI）。
结果
共有 22 篇文献纳入最终荟萃分析。薄子宫内膜组（EMT<7mm）的妊娠结局呈下降趋势，如活产率（LBR）、临床妊娠率（CPR）和着床率（IR）。相反，与中 EMT 组（EMT7-14mm）相比，厚子宫内膜（EMT>14mm）对妊娠结局无影响。此外，薄子宫内膜（EMT<7.5mm）增加了妊娠高血压疾病（HDP）和小于胎龄儿（SGA）婴儿的发生率，并降低了婴儿的出生体重（BW）。
结论
我们的研究表明，薄子宫内膜不仅对妊娠结局有不良影响，而且增加了产妇 HDP 和婴儿 SGA 的风险，或降低了婴儿 BW。厚子宫内膜对 IVF 结局没有不良影响。因此，需要告知患者薄子宫内膜可能导致的产科并发症和围产儿结局，并鼓励其积极配合围产期护理。
系统评价注册
（https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=242637），标识符 CRD42021242637。
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