Guo Ya-Bin, Tang Bin, Zhang Ling, Wu Xue, Huang Zhi-Hua
Center of Reproductive Medicine, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), Changde 415000, Hunan Province, China.
Department of Neurology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City), Changde 415000, Hunan Province, China.
World J Psychiatry. 2025 Sep 19;15(9):109175. doi: 10.5498/wjp.v15.i9.109175.
Despite advances in the use of fertilization-embryo transfer (ET) in couples with infertility, recurrent implantation failure (RIF) after ET is still a major problem affecting women, with great psychological and economic burdens for the patient and his/her family.
To investigate the psychological burden (anxiety and depression) and evaluate the clinical benefits of endometrial receptivity testing (ERT) in patients experiencing RIF following frozen-thawed ET.
A retrospective cohort study analyzed 371 patients experiencing RIF after assisted reproductive treatment at the First People's Hospital of Changde City between January 2021 and June 2024. Demographic and clinical data were systematically collected through standardized questionnaires. Psychological assessment utilized validated instruments: The Self-Rating Depression Scale for depression evaluation and the Self-Rating Anxiety Scale for anxiety assessment. Participants were stratified by psychological status (anxiety/non-anxiety and depression/non-depression) to analyze influencing factors for anxiety and depression. The cohort was further categorized into the ERT and non-ERT groups based on ERT implementation to comparatively analyze their clinical outcomes. Additionally, they were divided into clinical and nonclinical pregnancy groups to identify factors affecting clinical pregnancy using univariate and multivariate logistic regression models. Compared with the non-ERT group, the 226 patients who underwent ERT-guided ET achieved a higher clinical pregnancy rate, thicker endometrium on transfer day, fewer embryos transferred, and a lower miscarriage rate.
The study identified a substantial psychological burden, with anxiety prevalence at 55.0% (mean Self-Rating Anxiety Scale score, 50.89 ± 9.34) and depression at 61.2% (mean Self-Rating Depression Scale score, 55.55 ± 9.48). Multivariate analysis identified annual household income > 100000 yuan as protective factors against both anxiety and depression, whereas advanced maternal age (> 35 years) and multiple implantation failures (≥ 3) served as risk factors. Additionally, anxiety-specific risk factors included prolonged infertility treatment (> 5 years) and the spouse's status as an only child. As to depression-specific risks, chronic infertility (> 3 years) and higher educational attainment (college/bachelor's degree or higher) were key determinants, whereas urban residence was a protective factor. Age > 35 years was a risk factor for clinical pregnancy in patients experiencing RIF, whereas blastocyst-stage ET, a higher number of embryos transferred, and thicker endometrium were protective factors.
Patients experiencing RIF are particularly susceptible to anxiety and depression, and advanced maternal age and multiple implantation failures represent salient risk factors. Clinicians should implement proactive and evidence-based interventions to mitigate these psychological burdens. For patients experiencing RIF, ERT-guided ET demonstrates significant potential to improve assisted reproductive outcomes.
尽管在不孕夫妇中使用受精-胚胎移植（ET）技术取得了进展，但ET后的反复植入失败（RIF）仍然是影响女性的一个主要问题，给患者及其家庭带来了巨大的心理和经济负担。
调查心理负担（焦虑和抑郁），并评估子宫内膜容受性检测（ERT）对冻融ET后发生RIF的患者的临床益处。
一项回顾性队列研究分析了2021年1月至2024年6月期间在常德市第一人民医院接受辅助生殖治疗后发生RIF的371例患者。通过标准化问卷系统收集人口统计学和临床数据。心理评估采用经过验证的工具：用于抑郁评估的自评抑郁量表和用于焦虑评估的自评焦虑量表。参与者按心理状态（焦虑/非焦虑和抑郁/非抑郁）分层，以分析焦虑和抑郁的影响因素。根据ERT的实施情况，将队列进一步分为ERT组和非ERT组，以比较分析它们的临床结局。此外，将他们分为临床妊娠组和非临床妊娠组，使用单因素和多因素逻辑回归模型确定影响临床妊娠的因素。与非ERT组相比，接受ERT引导ET的226例患者临床妊娠率更高，移植日子宫内膜更厚，移植胚胎数量更少，流产率更低。
该研究发现存在严重的心理负担，焦虑患病率为55.0%（自评焦虑量表平均得分，50.89±9.34），抑郁患病率为61.2%（自评抑郁量表平均得分，55.55±9.48）。多因素分析确定家庭年收入>10万元是预防焦虑和抑郁的保护因素，而高龄产妇（>35岁）和多次植入失败（≥3次）是危险因素。此外，焦虑的特定危险因素包括不孕治疗时间延长（>5年）和配偶为独生子女。至于抑郁的特定风险，慢性不孕（>3年）和较高的教育程度（大专/本科学历或更高）是关键决定因素，而城市居住是一个保护因素。年龄>35岁是RIF患者临床妊娠的危险因素，而囊胚期ET、移植胚胎数量增加和子宫内膜增厚是保护因素。
发生RIF的患者特别容易出现焦虑和抑郁，高龄产妇和多次植入失败是显著的危险因素。临床医生应实施积极且基于证据的干预措施，以减轻这些心理负担。对于发生RIF的患者，ERT引导的ET显示出改善辅助生殖结局的巨大潜力。
