药物与临床

阿司匹林对子宫内膜异位症合并薄型子宫内膜冻融胚胎移植的影响

  • 周敏 ,
  • 张潇潇 ,
  • 吴钊
展开
  • 1.电子科技大学附属医院·四川省人民医院 妇产科生殖中心 (四川 成都 610072 )
    2.电子科技大学附属医院·四川省人民医院 妇产科 (四川 成都 610072 )

收稿日期: 2024-05-06

  网络出版日期: 2025-01-14

基金资助

国家自然科学基金资助项目(81801423);四川省自然科学基金项目(2022NSFSC1499);四川省医学青年创新课题计划(Q23034);成都市卫健委医学科研课题(2024580)

The effect of aspirin on frozen thawed embryo transfer in endometriosis with thin endometrium

  • Min ZHOU ,
  • Xiaoxiao ZHANG ,
  • Zhao WU
Expand
  • Center for Reproductive Medicine,Department of Obstetrics and Gynecology,Sichuan Provincial People's Hospital,School of Medicine,University of Electronic Science and Technology of China,Chengdu 610072,Sichuan,China

Received date: 2024-05-06

  Online published: 2025-01-14

摘要

目的 分析子宫内膜异位症合并薄型内膜患者行冻融胚胎移植时,加用阿司匹林对内膜和妊娠结局的影响。 方法 收集2019年1月至2023年5月在四川省人民医院行冻融胚胎移植的子宫内膜异位症患者,雌激素治疗后内膜厚度< 7 mm,加大雌激素剂量+阿司匹林组(观察组,n = 162)与仅加大雌激素剂量组(对照组,n = 152),比较移植前内膜参数和妊娠结局。 结果 与对照组相比,观察组的搏动指数(PI)[(0.77 ± 0.20) vs. (0.84 ± 0.27),P < 0.05]、阻力指数(RI)[(0.49 ± 0.10) vs. (0.63 ± 0.10),P < 0.01]和收缩期峰值/舒张末期流速(S/D)[(1.94 ± 0.49) vs. (2.22 ± 0.47),P < 0.01]降低;同时胚胎着床率(38.00% vs. 27.24%,P < 0.01)、临床妊娠率(56.17% vs. 42.11%,P < 0.05)和活产率(84.62% vs. 68.75%,P < 0.05)升高。 结论 子宫内膜异位症薄型内膜患者在冻融胚胎移植时,加用阿司匹林后子宫及螺旋动脉血流显著改变,可改善妊娠结局。

本文引用格式

周敏 , 张潇潇 , 吴钊 . 阿司匹林对子宫内膜异位症合并薄型子宫内膜冻融胚胎移植的影响[J]. 实用医学杂志, 2025 , 41(1) : 95 -99 . DOI: 10.3969/j.issn.1006-5725.2025.01.016

Abstract

Objective To analyze the effect of aspirin addition on endometrial conditions and pregnancy outcomes in endometriosis-related patients with thin endometrium. Methods A retrospective analysis was conducted on endometriosis-related patients with thin endometrium (thickness < 7 mm) undergoing frozen-thawed embryo transfer at the Reproductive Medical Centre from January 2019 to May 2023 was conducted. Patients undergoing hormone replacement therapy with aspirin (Observation group, n = 162) were compared with those receiving increased estrogen alone (Control group, n = 152). Endometrial parameters before embryo transfer and clinical outcomes were compared between the groups. Results Compared to the Control group, the Observation group showed significant improvements in pulsatility index (PI) [(0.77 ± 0.20) vs. (0.84 ± 0.27),P < 0.05], resistance index (RI) [(0.49 ± 0.10) vs. (0.63 ± 0.10),P < 0.01], and systolic/diastolic (S/D) ratio [(1.94 ± 0.49) vs. (2.22 ± 0.47),P < 0.01]. Moreover, there was a significant increase in the embryo implantation rate (38.00% vs. 27.24%, P < 0.01), clinical pregnancy rate (56.17% vs. 42.11%, P < 0.05) and live birth rate (84.62% vs. 68.75%, P < 0.05). Conclusion In endometriosis-related patients with thin endometrium, the addition of aspirin significantly improved uterine and spiral artery blood flow, thereby enhancing pregnancy outcomes during frozen-thawed embryo transfer.

参考文献

1 LESSEY B A, YOUNG S L. What exactly is endometrial receptivity?[J]. Fertil Steril, 2019, 111(4): 611-617. doi:10.1016/j.fertnstert.2019.02.009
2 PIRTEA P, DE ZIEGLER D, AYOUBI J M. Endometrial receptivity in adenomyosis and/or endometriosis[J]. Fertil Steril, 2023, 119(5): 741-745. doi:10.1016/j.fertnstert.2023.03.004
3 BULUN S E, YILDIZ S, ADLI M, et al. Endometriosis and adenomyosis: Shared pathophysiology[J]. Fertil Steril,2023, 119(5): 746-750. doi:10.1016/j.fertnstert.2023.03.006
4 PATHARE A D S, LOID M, SAARE M, et al. Endometrial receptivity in women of advanced age: an underrated factor in infertility[J]. Hum Reprod Update, 2023, 29(6): 773-793. doi:10.1093/humupd/dmad019
5 GANGARAJU B, MAHAJAN P, SUBRAMANIAN S, et al. Lyophilized Platelet-rich plasma for the management of thin endometrium and facilitation of in-vitro fertilization[J]. JBRA Assist Reprod, 2023, 27(1): 55-59.
6 MADANI T, AHMADI F, JAHANGIRI N, et al. Does low-dose aspirin improve pregnancy rate in women undergoing frozen-thawed embryo transfer cycle? A pilot double-blind, randomized placebo-controlled trial[J]. J Obstet Gynaecol Res, 2019, 45(1): 156-163. doi:10.1111/jog.13802
7 BELHOMME N, DOUDNIKOFF C, POLARD E, et al. Aspirin: Indications and use during pregnancy[J]. Rev Med Interne,2017, 38(12): 825-832. doi:10.1016/j.revmed.2017.10.419
8 郭春, 冯桂梅, 张潇潇, 等. 盆腔输卵管因素不孕且前次助孕失败患者再次冻融胚胎移植中应用GnRH-a的临床妊娠结局分析[J]. 实用妇产科杂志, 2023, 39(10): 763-768.
9 LIN Y, DONG S, YE X, et al. Synergistic regenerative therapy of thin endometrium by human placenta-derived mesenchymal stem cells encapsulated within hyaluronic acid hydrogels[J]. Stem Cell Res Ther, 2022, 13(1): 66. doi:10.1186/s13287-022-02717-2
10 XU L, FAN Y, WANG J, et al. Dysfunctional intercellular communication and metabolic signaling pathways in thin endometrium[J]. Front Physiol, 2022, 13: 1050690. doi:10.3389/fphys.2022.1050690
11 ZHENG Y, CHEN B, DAI J, et al. Thin endometrium is associated with higher risks of preterm birth and low birth weight after frozen single blastocyst transfer[J]. Front Endocrinol (Lausanne), 2022, 13:1040140. doi:10.3389/fendo.2022.1040140
12 VARTANYAN E, TSATUROVA K, DEVYATOVA E. Thin endometrium problem in IVF programs[J]. Gynecol Endocrinol,2020, 36(sup1): 24-27. doi:10.1080/09513590.2020.1816724
13 PIRTEA P, CICINELLI E, DE NOLA R, et al. Endometrial causes of recurrent pregnancy losses: Endometriosis, adenomyosis, and chronic endometritis[J]. Fertil Steril, 2021, 115(3): 546-560.. doi:10.1016/j.fertnstert.2020.12.010
14 PULUMATI A, ALGARIN Y A, JAALOUK D, et al. Aspirin as a chemopreventive agent for cutaneous melanoma: A literature review[J]. Arch Dermatol Res, 2024, 316(7):367. doi:10.1007/s00403-024-03056-3
15 MATHER A R, DOM A M, THORBURG L L. Low-dose aspirin in pregnancy: who when how much?and why? [J]. Curr Opin Obstet Gynecol, 2021, 33(2): 65-71. doi:10.1097/gco.0000000000000694
16 ROLNIK D L, NICOLAIDES K H, POON L C. Prevention of preeclampsia with aspirin[J]. Am J Obstet Gynecol, 2022, 226(2S): S1108-S1119. doi:10.1016/j.ajog.2020.08.045
17 DHILLON-SMITH R K, MELO P, KAUR R, et al. Interventions to prevent miscarriage[J]. Fertil Steril, 2023, 120(5): 951-954. doi:10.1016/j.fertnstert.2023.08.955
18 HSIEH Y Y, TSAI H D, CHANG C C, et al. Low-dose aspirin for infertile women with thin endometrium receiving intrauterine insemination: a prospective, randomized study[J]. J Assist Reprod Genet, 2000, 17(3): 174-177.
19 MURPHY L, SALDANHA I J, SAWYER K, et al. Association Between Low-Dose Aspirin and Development of Gestational Diabetes: A Systematic Review and Meta-Analysis[J]. J Obstet Gynaecol Can, 2022, 44(9): 997-1003. doi:10.1016/j.jogc.2022.05.008
20 LI L N, LI X D, DU J. The effect of aspirin on uterine arterial blood flow and endometrium in moderate and severe intrauterine adhesion after transcervical resection of adhesion: A systematic review and meta-analysis[J]. J Matern Fetal Neonatal Med, 2023, 36(1): 2209818. doi:10.1080/14767058.2023.2209818
21 ZHANG X, GUO F, WANG Q, et al. Low-dose aspirin improves blood perfusion of endometrium of unexplained recurrent biochemical pregnancy loss[J]. Int J Gynaecol Obstet,2022, 157(2): 418-423. doi:10.1002/ijgo.13838
22 ZHANG X, GUO F, WANG Q, et al. Low-dose aspirin treatment improves endometrial receptivity in the midluteal phase in unexplained recurrent implantation failure[J]. Int J Gynaecol Obstet,2022, 156(2): 225-230. doi:10.1002/ijgo.13699
23 ZHANG Z, LI S, DENG J, et al. Aspirin inhibits endometrial fibrosis by suppressing the TGF-β1-Smad2/Smad3 pathway in intrauterine adhesions[J]. Int J Mol Med, 2020, 45(5): 1351-1360.
24 MURPHY E, CURNEEN J M G, MCEVOY J W. Aspirin in the Modern Era of Cardiovascular Disease Prevention[J]. Methodist Debakey Cardiovasc J, 2021, 17(4): 36-47. doi:10.14797/mdcvj.293
25 周敏, 郭春. 子宫内膜异位症性不孕患者自然妊娠及IVF/ICSI后早期自然流产率的回顾性研究[J]. 实用医学杂志, 2021, 37(19): 2464-2467.
文章导航

/