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薄型子宫内膜患者胚胎移植后成功活产的病例报告

A Case Report of Successful Live Pregnancy Following Embryo Transfer in a Thin Endometrium.

作者信息

Ali Jijisha, Magray Shazia, Ahmed Eman, Talo Sami

机构信息

Obstetrics and Gynaecology, Mediclinic Welcare Hospital, Mediclinic Middle East, Dubai, ARE.

Reproductive Medicine and Infertility, Bourn Hall Fertility Centre, Mediclinic Middle East, Dubai, ARE.

出版信息

Cureus. 2024 Aug 7;16(8):e66363. doi: 10.7759/cureus.66363. eCollection 2024 Aug.

DOI:10.7759/cureus.66363
PMID:39246935
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11378461/
Abstract

Managing a thin endometrium is a common challenge in assisted reproductive treatments. The thickness of the endometrium is crucial for embryo implantation, with younger patients generally having higher success rates even with a thinner lining. A frozen embryo transfer cycle often allows for a more thorough assessment of the endometrium compared to a fresh transfer. We present a case of a 36-year-old woman who presented to our fertility center with primary infertility for six years. Despite having regular menstrual cycles, her endometrial thickness consistently measured between 5 and 6.0 mm on ultrasonography. She underwent ovarian stimulation using an antagonist protocol, resulting in the retrieval of oocytes and the freezing of three embryos. However, three frozen embryo transfer cycles were cancelled due to inadequate endometrial thickness (ranging from 4.3 to 5.2 mm). In the fourth cycle, she was treated with gonadotropins with the goal of achieving two to three follicles and improved endometrial thickness. Triggering was performed on day 15, followed by the transfer of one frozen embryo at an endometrial thickness of 5.7 mm. Her beta-human chorionic gonadotropin (hCG) level was positive, with an initial value of 136.9 mIU/mL, and she subsequently delivered a healthy baby. This case highlights the challenges of managing a thin endometrium in assisted reproductive techniques. Through persistent efforts and tailored treatment protocols, a successful live birth was achieved despite recurrent thin endometrium. This case underscores the importance of individualized treatment strategies in overcoming endometrial challenges in infertility treatments.

摘要

在辅助生殖治疗中,处理薄型子宫内膜是一个常见的挑战。子宫内膜的厚度对于胚胎着床至关重要,年轻患者即使内膜较薄通常也有较高的成功率。与新鲜胚胎移植相比,冷冻胚胎移植周期往往能对子宫内膜进行更全面的评估。我们报告一例36岁女性,因原发性不孕六年前来我们的生育中心就诊。尽管月经周期规律,但超声检查显示她的子宫内膜厚度始终在5至6.0毫米之间。她采用拮抗剂方案进行卵巢刺激,成功获取了卵母细胞并冷冻了三个胚胎。然而,由于子宫内膜厚度不足(4.3至5.2毫米),三次冷冻胚胎移植周期均被取消。在第四个周期,她接受了促性腺激素治疗,目标是获得两到三个卵泡并改善子宫内膜厚度。在第15天进行扳机注射,随后在子宫内膜厚度为5.7毫米时移植了一枚冷冻胚胎。她的β-人绒毛膜促性腺激素(hCG)水平呈阳性,初始值为136.9 mIU/mL,随后她顺利产下一名健康婴儿。该病例凸显了辅助生殖技术中处理薄型子宫内膜的挑战。尽管子宫内膜反复变薄,但通过持续努力和量身定制的治疗方案,仍成功实现了活产。该病例强调了个体化治疗策略在克服不孕症治疗中子宫内膜相关挑战方面的重要性。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/46d9/11378461/f1f28f8776d6/cureus-0016-00000066363-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/46d9/11378461/d85683c423a9/cureus-0016-00000066363-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/46d9/11378461/684f7c95d3c9/cureus-0016-00000066363-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/46d9/11378461/f1f28f8776d6/cureus-0016-00000066363-i03.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/46d9/11378461/d85683c423a9/cureus-0016-00000066363-i01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/46d9/11378461/684f7c95d3c9/cureus-0016-00000066363-i02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/46d9/11378461/f1f28f8776d6/cureus-0016-00000066363-i03.jpg

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本文引用的文献

1
Successful live birth of thin endometrium: A case report.薄型子宫内膜成功妊娠活产:病例报告。
Medicine (Baltimore). 2024 Mar 1;103(9):e37399. doi: 10.1097/MD.0000000000037399.
2
Intrauterine Administration of Autologous Platelet-Derived Growth Factor Concentrate (aka Autologous Blood Cell Derivative) Improves the Endometrial Thickness in 'Thin' Endometrium in the Frozen Embryo Transfer Cycle.宫腔内注射自体血小板衍生生长因子浓缩物(又名自体血细胞衍生物)可改善冻融胚胎移植周期中“薄型”子宫内膜的厚度。
J Obstet Gynaecol India. 2023 Oct;73(Suppl 1):108-114. doi: 10.1007/s13224-022-01735-7. Epub 2023 Apr 22.
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Is frozen embryo transfer better than fresh embryo transfer in women undergoing intracytoplasmic sperm injection over the age of thirty-five? A single referral centre experience.
对于 35 岁以上接受胞浆内单精子注射的女性,冻融胚胎移植是否优于新鲜胚胎移植?单中心经验。
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Fresh versus frozen embryo transfer in women with thin endometrium: a retrospective cohort study.子宫内膜薄的女性进行新鲜胚胎移植与冷冻胚胎移植的比较:一项回顾性队列研究。
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The impact of endometrial thickness (EMT) on the day of human chorionic gonadotropin (hCG) administration on pregnancy outcomes: a 5-year retrospective cohort analysis in Malaysia.人绒毛膜促性腺激素(hCG)给药当天子宫内膜厚度(EMT)对妊娠结局的影响:马来西亚一项为期5年的回顾性队列分析。
Fertil Res Pract. 2018 Aug 11;4:5. doi: 10.1186/s40738-018-0050-8. eCollection 2018.
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Endometrial thickness in women undergoing IUI with ovarian stimulation. How thick is too thin? A systematic review and meta-analysis.接受卵巢刺激的宫内人工授精女性的子宫内膜厚度。多薄才算太薄?一项系统评价和荟萃分析。
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The effect of endometrial thickness on the day of hCG administration on pregnancy outcome in the first fresh IVF/ICSI cycle.在首次新鲜体外受精/卵胞浆内单精子注射周期中,人绒毛膜促性腺激素(hCG)给药当天的子宫内膜厚度对妊娠结局的影响。
Gynecol Endocrinol. 2016 Jun;32(6):473-6. doi: 10.3109/09513590.2015.1132304. Epub 2016 Jan 8.
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