Nishii Shogo, Ezoe Kenji, Nishihara Seiko, Onogi Sachie, Takeshima Kazumi, Karakida Shinya, Fukuda Junichiro, Kato Keiichi
Kato Ladies Clinic, Shinjuku, Tokyo, Japan.
Department of Obstetrics and Gynecology, School of Medicine, Showa University, Tokyo, Japan.
AJOG Glob Rep. 2023 Jan 18;3(1):100161. doi: 10.1016/j.xagr.2023.100161. eCollection 2023 Feb.
Although a recent study reported that the pregnancy outcomes in the first trimester were more correlated with endometrial thickness on the day of the trigger than with endometrial thickness on the day of single fresh-cleaved embryo transfer, it remains unclear whether endometrial thickness on the day of the trigger can predict live birth rate after a single fresh-cleaved embryo transfer.
This study aimed to examine whether endometrial thickness on the trigger day is associated with live birth rates and whether modifying the single fresh-cleaved embryo transfer criteria to reflect endometrial thickness on the trigger day improved the live birth rate and reduced maternal complications in a clomiphene citrate-based minimal stimulation cycle.
This was a retrospective study of the outcomes of 4440 treatment cycles of women who underwent single fresh-cleaved embryo transfer on day 2 of the retrieval cycle. From November 2018 to October 2019, single fresh-cleaved embryo transfer was performed when endometrial thickness on the day of single fresh-cleaved embryo transfer was ≥8 mm (criterion A). From November 2019 to August 2020, single fresh-cleaved embryo transfer was conducted when endometrial thickness on the day of the trigger was ≥7 mm (criterion B).
A multivariate logistic regression analysis revealed that increased endometrial thickness on the trigger day was significantly associated with an improvement in the live birth rate after single fresh-cleaved embryo transfer (adjusted odds ratio, 1.098; 95% confidence interval, 1.021-1.179). The live birth rate was significantly higher in the criterion B group than in the criterion A group (22.9% and 19.1%, respectively; =.0281). Although endometrial thickness on the day of single fresh-cleaved embryo transfer was sufficient, the live birth rate tended to be lower when endometrial thickness on the trigger day was <7.0 mm than when endometrial thickness on the day of the trigger was ≥7.0 mm. The risk for placenta previa was reduced in the criterion B group when compared with the criterion A group (4.3% and 0.6%, respectively; =.0222).
This study demonstrated an association of decreased endometrial thickness on the trigger day with low birth rate and a high incidence of placenta previa. A modification of the criteria for a single fresh-cleaved embryo transfer based on endometrial thickness may improve pregnancy and maternal outcomes.
尽管最近一项研究报告称，孕早期的妊娠结局与扳机日的子宫内膜厚度比与单枚新鲜卵裂胚移植日的子宫内膜厚度相关性更强，但扳机日的子宫内膜厚度能否预测单枚新鲜卵裂胚移植后的活产率仍不清楚。
本研究旨在探讨扳机日的子宫内膜厚度是否与活产率相关，以及在枸橼酸氯米芬为基础的轻度刺激周期中，修改单枚新鲜卵裂胚移植标准以反映扳机日的子宫内膜厚度是否能提高活产率并减少母体并发症。
这是一项对4440个取卵周期第2天接受单枚新鲜卵裂胚移植的女性治疗周期结局的回顾性研究。2018年11月至2019年10月，当单枚新鲜卵裂胚移植日的子宫内膜厚度≥8mm时进行单枚新鲜卵裂胚移植（标准A）。2019年11月至2020年8月，当扳机日的子宫内膜厚度≥7mm时进行单枚新鲜卵裂胚移植（标准B）。
多因素logistic回归分析显示，扳机日子宫内膜厚度增加与单枚新鲜卵裂胚移植后活产率提高显著相关（调整优势比，1.098；95%置信区间，1.021-1.179）。标准B组的活产率显著高于标准A组（分别为 22.9%和19.1%；P = 0.0281）。尽管单枚新鲜卵裂胚移植日的子宫内膜厚度足够，但当扳机日的子宫内膜厚度<7.0mm时，活产率往往低于扳机日的子宫内膜厚度≥7.0mm时。与标准A组相比，标准B组前置胎盘的风险降低（分别为4.3%和0.6%；P = 0.0222）。
本研究表明扳机日子宫内膜厚度降低与低出生率和前置胎盘高发生率相关。基于子宫内膜厚度修改单枚新鲜卵裂胚移植标准可能改善妊娠和母体结局。
