子宫内膜致密化并不预测玻璃化冷冻-解冻胚胎移植后的生殖结局：一项前瞻性队列研究。
Endometrial compaction does not predict the reproductive outcome after vitrified-warmed embryo transfer: a prospective cohort study.
机构信息
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Akdeniz University, Faculty of Medicine, Antalya 07059, Turkey; Department of Obstetrics and Gynecology, Akdeniz University, Faculty of Medicine, Antalya 07059, Turkey.
Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Akdeniz University, Faculty of Medicine, Antalya 07059, Turkey; Department of Obstetrics and Gynecology, Akdeniz University, Faculty of Medicine, Antalya 07059, Turkey.
出版信息
Reprod Biomed Online. 2022 Jul;45(1):81-87. doi: 10.1016/j.rbmo.2022.02.025. Epub 2022 Mar 5.
RESEARCH QUESTION
Does endometrial compaction, determined by both transvaginal (TVUS) and abdominal ultrasonography (AUS), improve reproductive outcomes in vitrified-warmed embryo transfer (FET) cycles, and is there a correlation between compaction and serum progesterone concentrations on day of embryo transfer?
DESIGN
Prospective observational cohort study at a single tertiary care IVF centre including 204 patients undergoing high-quality vitrified-warmed blastocyst transfer in a hormone replacement therapy (HRT) cycle. The change in endometrial thickness (EMT) between end of oestrogen-only phase and day of embryo transfer, as measured by sequential TVUS, was used to categorize endometrium as undergoing compaction (≥5% decrease), no change, or expansion (≥5% increase). EMT was also examined using AUS at the time of embryo transfer. Primary outcome measure was ongoing pregnancy rates.
RESULTS
Thirty-one cycles (15.2%) demonstrated compaction, whereas 123 (60.3%) expanded and 50 (24.5%) remained unchanged as measured by sequential TVUS. Ongoing pregnancy rates did not differ among cycles with compaction (58.1%), those with expansion (56.9%), and those with no change (60.0%; P=0.932). Furthermore, oestrogen, progesterone and oestrogen/progesterone concentrations on day of embryo transfer were comparable among all groups. Using AUS, endometrial compaction was seen in 46 cycles (22.5%), and there was a positive correlation between body mass index and AUS-measured EMT change (ρ = 0.161, P = 0.021). In the group with AUS-determined endometrial compaction, AUS measurements showed a significantly thinner EMT on day of embryo transfer (8.3 mm; interquartile range [IQR] [7.5; 9.2] versus 9.3 mm; IQR [8.4; 11.4], P < 0.001) and higher for EMT change (1.3 mm; IQR [0.8; 1.7] versus 0.1 mm; IQR [-1.1; 1.0], P < 0.001) compared with TVUS measurements.
CONCLUSIONS
Endometrial compaction during HRT-FET does not predict ongoing pregnancy.
研究问题
经阴道超声（TVUS）和腹部超声（AUS）联合检测的子宫内膜致密化是否能改善玻璃化冷冻胚胎解冻移植（FET）周期的妊娠结局，以及胚胎移植日的致密化与血清孕酮浓度之间是否存在相关性？
设计
在一家单中心的三级体外受精（IVF）中心进行的前瞻性观察性队列研究，纳入了 204 名接受激素替代疗法（HRT）周期中高质量玻璃化冷冻胚胎解冻移植的患者。通过连续 TVUS 测量，从雌激素单药治疗结束到胚胎移植日的子宫内膜厚度（EMT）变化，将子宫内膜分为致密化（≥5%减少）、无变化或扩张（≥5%增加）。在胚胎移植时还使用 AUS 检查 EMT。主要观察指标为持续妊娠率。
结果
31 个周期（15.2%）表现为致密化，而 123 个周期（60.3%）扩张，50 个周期（24.5%）无变化，这是通过连续 TVUS 测量得出的。致密化组（58.1%）、扩张组（56.9%）和无变化组（60.0%）的持续妊娠率无差异（P=0.932）。此外，胚胎移植日的雌激素、孕酮和雌孕激素浓度在所有组之间无差异。使用 AUS，46 个周期（22.5%）表现为子宫内膜致密化，体质量指数与 AUS 测量的 EMT 变化呈正相关（ρ=0.161，P=0.021）。在 AUS 确定的子宫内膜致密化组中，AUS 测量的 EMT 在胚胎移植日明显更薄（8.3mm；四分位距[IQR] [7.5；9.2] 与 9.3mm；IQR [8.4；11.4]，P<0.001），且 EMT 变化更大（1.3mm；IQR [0.8；1.7] 与 0.1mm；IQR [-1.1；1.0]，P<0.001），与 TVUS 测量结果相比。
结论
HRT-FET 期间的子宫内膜致密化不能预测持续妊娠。
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