复杂的子宫腔异常会增加新鲜周期辅助妊娠中体外受精/胞浆内单精子注射后流产的风险。

Complex Uterine Cavity Abnormalities Increase the Risk of Miscarriage in In Vitro Fertilization/Intracytoplasmic Sperm Injection in Fresh Cycle-Assisted Pregnancies.

机构信息

Center of Reproductive Medicine and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (all authors).

Center of Reproductive Medicine and Henan Key Laboratory of Reproduction and Genetics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China (all authors)..

出版信息

J Minim Invasive Gynecol. 2022 Jul;29(7):891-904. doi: 10.1016/j.jmig.2022.04.010. Epub 2022 Apr 28.

DOI:10.1016/j.jmig.2022.04.010

PMID:35490938

Abstract

STUDY OBJECTIVE

Any abnormality of the uterine cavity can result in reduced endometrial receptivity, which negatively affects embryo implantation and leads to lower clinical pregnancy rates. The effects of improved uterine cavity environment on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI)-embryo transfer (ET) treatment outcome are unclear. This study aimed to investigate the impact of improved uterine cavity abnormalities on the pregnancy outcomes of infertile patients undergoing IVF/ICSI-ET.

DESIGN

Retrospective study.

SETTING

Single-center.

PATIENTS

Women with infertility who underwent fresh cycles of IVF/ICSI-ET.

INTERVENTIONS

We retrospectively analyzed the clinical data of 31 057 cycles of women with infertility undergoing IVF/ICSI-ET with hysteroscopy and treated at the First Affiliated Hospital of Zhengzhou University Reproductive Medicine Center from August 2009 to May 2018. According to the previous condition of their uterine cavity, patients were divided into the normal uterine cavity, single uterine cavity abnormality, and complex uterine cavity abnormality groups. Differences in general conditions and pregnancy-assisted outcomes were compared among the groups, which were screened according to propensity score matching.

MEASUREMENTS AND MAIN RESULTS

In 3005 cycles after propensity score matching screening, there were no statistically significant differences in the implantation and clinical pregnancy rates of patients with successfully treated uterine cavity abnormalities and lesions (p > .05). The miscarriage rate was significantly higher in the complex uterine cavity abnormality group than in the normal (p = .001) and single uterine cavity abnormality groups (p = .002). Logistic regression analysis showed that the female partner's age (adjusted odds ratio, 1.12; 95% confidence interval, 1.05-1.19; p = .001) and history of intrauterine adhesions (adjusted odds ratio, 1.44; 95% confidence interval, 1.12-1.85; p = .005) were independent risk factors for miscarriage.

CONCLUSION

The age of the female partner and history of intrauterine adhesions increased the miscarriage rate in patients undergoing IVF/ICSI-ET.

摘要

研究目的

子宫腔的任何异常都可能导致子宫内膜容受性降低，从而对胚胎着床产生负面影响，并导致临床妊娠率降低。改善子宫腔环境对体外受精（IVF）/卵胞浆内单精子注射（ICSI）-胚胎移植（ET）治疗结局的影响尚不清楚。本研究旨在探讨改善子宫腔异常对接受 IVF/ICSI-ET 的不孕患者妊娠结局的影响。

设计

回顾性研究。

地点

单中心。

患者

在郑州大学第一附属医院生殖医学中心接受 IVF/ICSI-ET 的不孕患者，进行新鲜周期 IVF/ICSI-ET。

干预措施

我们回顾性分析了 2009 年 8 月至 2018 年 5 月期间在郑州大学第一附属医院生殖医学中心接受 IVF/ICSI-ET 并接受宫腔镜检查的 31057 例不孕患者的临床数据。根据子宫腔的既往情况，将患者分为正常子宫腔、单一子宫腔异常和复杂子宫腔异常组。根据倾向评分匹配对各组进行筛选，比较各组的一般情况和妊娠辅助结局的差异。

测量和主要结果

在经过倾向评分匹配筛选的 3005 个周期中，成功治疗的子宫腔异常和病变患者的着床和临床妊娠率没有统计学差异（p>0.05）。复杂子宫腔异常组的流产率明显高于正常组（p=0.001）和单一子宫腔异常组（p=0.002）。Logistic 回归分析显示，女性伴侣年龄（调整优势比，1.12；95%置信区间，1.05-1.19；p=0.001）和宫腔粘连病史（调整优势比，1.44；95%置信区间，1.12-1.85；p=0.005）是流产的独立危险因素。