宫腔粘连分离术后冻融周期囊胚移植对妊娠结局的影响

doi:10.3969/j.issn.1006-5725.2024.17.006

Abstract

Abstract:

Objective To explore the assisted reproductive strategy and influencing factors for patients undergoing frozen?thawed cycle blastocyst transfer after hysteroscopic adhesiolysis for intrauterine adhesions. Methods A total of 275 patients who underwent frozen?thawed cycle blastocyst transfer after hysteroscopic adhesiolysis for infertility reasons at the Reproductive Genetics Center of the First Affiliated Hospital of University of Science and Technology of China from January 2018 to December 2022 were included in the study. They were divided into a single blastocyst transfer group （n = 182） and a double blastocyst transfer group （n = 93）. The clinical outcomes were analyzed and compared retrospectively between the group. Results The two groups showed no statistically significant differences in terms of age， day of endometrial thickness conversion， endometrial preparation method， clinical pregnancy rate， miscarriage rate， preterm birth rate， gestational week at delivery， and mode of delivery （P > 0.05）. The single blastocyst transfer group had significantly lower infertility duration （years）（2.43 ± 1.64 vs. 3.03 ± 2.13， P < 0.05）， significantly lower AFS prognosis score （5.13 ± 2.25 vs. 5.72 ± 2.19， P < 0.05）， and significantly lower multiple pregnancy rate （1.33% vs. 28.57%， P < 0.05）， but significantly higher quality embryo rate （90.66% vs. 46.24%， P < 0.05）， implantation rate （50.00% vs. 34.41%， P < 0.05）， and live infant mass （g）（3 236.84 ± 565.35 vs. 2 976.44 ± 692.79， P < 0.05） compared to the double blastocyst transfer group. Binary logistic regression analysis showed that the number of high?quality embryos transferred and AFS score were independent influencing factors for clinical pregnancy （P < 0.05）. Conclusions The number of high?quality embryos transferred and the AFS score are independent influencing factors for clinical pregnancy in patients undergoing frozen?thawed cycle blastocyst transfer after hysteroscopic adhesiolysis for intrauterine adhesions. Single high?quality blastocyst transfer is a preferred treatment for patients after hysteroscopic adhesiolysis， and double blastocyst transfer is favorable for patients with a poor prognosis to achieve better pregnancy outcomes.

Key words: intrauterine adhesion, frozen?thawed cycle, blastocyst, factors, pregnancy outcome

CLC Number:

R711.6

Cheng LIU,Meiying SANG,Qunying FANG,Shun BAI,Meihong HU,Shengxia. ZHENG. Strategy for frozen⁃thawed cycle blastocyst transfer after hysteroscopic adhesiolysis[J]. The Journal of Practical Medicine, 2024, 40(17): 2390-2394.

Figures/Tables 3

Tab.1

Tab.2

Tab.3

References 26

1	夏恩兰. 宫腔镜学及图谱［M］. 2版，郑州：河南科学技术出版社，2009：279-297.
2	何均，刁红录，张昌军，等. 宫腔镜下宫腔粘连分离术后行体外受精-胚胎移植的妊娠结局及影响因素［J］. 实用妇产科杂志，2019，35（12）：941-944.
3	The American Fertility Society classifications of adnexal adhesions， distal tubal occlusion， tubal occlusion secondary to tubal ligation， pregnancies tubal， mullerian anomalies and intrauterine adhesions［J］. Fertil Steril，1988，49（6）：944-955. doi:10.1016/s0015-0282(16)59942-7 doi: 10.1016/s0015-0282(16)59942-7
4	刘景瑜，朱颖春，孔娜，等. 薄型子宫内膜患者冻融胚胎移植周期17β雌二醇、人绝经期促性腺激素及他莫昔芬三种内膜准备方案临床结果比较［J］. 生殖医学杂志， 2018，27（2）：112-116. doi:10.3969/j.issn.1004-3845.2018.02.003 doi: 10.3969/j.issn.1004-3845.2018.02.003
5	李静，乔洪武，管一春，等. 单囊胚移植在新鲜移植周期与冻融移植周期中的应用［J］. 深圳中西医结合杂志， 2019，29（8）：10-11. doi:10.16458/j.cnki.1007-0893.2019.08.004 doi: 10.16458/j.cnki.1007-0893.2019.08.004
6	EMILY C H， BANAFSHEH N K， SARA S M，et al. Improved outcomes after blastocyst-stage frozen-thawed embryo transfers compared with cleavage stage： a society for assisted reproductive technologies clinical outcomes reporting system study［J］.Fertil Steril，2018，110（1）：89-94. doi:10.1016/j.fertnstert.2018.03.033 doi: 10.1016/j.fertnstert.2018.03.033
7	MATHEUS R， KARINNA L， SANDRA S，et al. Fresh embryo transfer versus frozen embryo transfer in in vitro fertilization cycles： a systematic review and meta-analysis［J］. Fertil Steril，2013，99（1）：156-162. doi:10.1016/j.fertnstert.2012.09.003 doi: 10.1016/j.fertnstert.2012.09.003
8	DENG K， SONG X H， HAN X M， et al. Optimal waiting period for fresh embryo transfer after hysteroscopic adhesiolysis： a retrospective cohort study［J］. Chin Med J （Engl）， 2019， 132（19）： 2333-2339. doi:10.1097/cm9.0000000000000456 doi: 10.1097/cm9.0000000000000456
9	YIMIN Z， MINYUE T， YANLING F， et al. Fetal reduction could improve but not completely reverse the pregnancy outcomes of multiple pregnancies： experience from a single center［J］. Front Endocrinol （Lausanne）， 2022，24（13）：851167.
10	ELINE M， LAURA D R， ESMEE M B，et al. Birth outcomes of twins after multifetal pregnancy reduction compared with primary twins［J］. Am J Obstet Gynecol MFM， 2024，6（1）：101230. doi:10.1016/j.ajogmf.2023.101230 doi: 10.1016/j.ajogmf.2023.101230
11	XIN L， YI W， TING L，et al. Clinical outcomes of vanishing twin syndrome and selective fetal reduction after double embryos transferred in IVF pregnancy： A propensity score matching study［J］.Eur J Obstet Gynecol Reprod Biol， 2023， 289：48-54. doi:10.1016/j.ejogrb.2023.08.372 doi: 10.1016/j.ejogrb.2023.08.372
12	高红，王蔼明，林莉，等. 新鲜周期选择性单囊胚与双囊胚移植临床结局的比较［J］. 生殖医学杂志， 2017，26（12）：1182-1186. doi:10.3969/j.issn.1004-3845.2017.12.004 doi: 10.3969/j.issn.1004-3845.2017.12.004
13	刘景，孔红娇，胡继君，等. 冷冻复苏周期不同囊胚移植方案对不同年龄患者妊娠结局的影响［J］. 实用医学杂志， 2020，36（7）：925-929. doi:10.3969/j.issn.1006-5725.2020.07.018 doi: 10.3969/j.issn.1006-5725.2020.07.018
14	李明颖，马艳萍，高梦莹，等. 囊胚质量对冻融胚胎移植临床结局的影响及囊胚移植选择策略［J］. 实用医学杂志， 2018，34（15）：2453-2456. doi:10.3969/j.issn.1006-5725.2018.15.001 doi: 10.3969/j.issn.1006-5725.2018.15.001
15	HADAS G H， ALEXANDER V P， TUYET N T N，et al. Does embryo quality at transfer affect obstetric outcomes and placental findings？［J］. Hum Reprod， 2023，38（5）：853-859. doi:10.1093/humrep/dead045 doi: 10.1093/humrep/dead045
16	SAMUEL J A， MARIA T L， ESSAM M，et al. Effect of transfer of a poor quality embryo along with a top quality embryo on the outcome during fresh and frozen in vitro fertilization cycles［J］. Fertil Steril， 2018，110（4）：655-660. doi:10.1016/j.fertnstert.2018.05.010 doi: 10.1016/j.fertnstert.2018.05.010
17	季晓媛，赵纯，李秀玲，等. 宫腔粘连术后影响FET成功率的临床因素探讨［J］. 中国妇幼健康研究， 2016，27（4）：493-496. doi:10.3969/j.issn.1673-5293.2016.04.026 doi: 10.3969/j.issn.1673-5293.2016.04.026
18	周晓景，谭丽，王芬，等. 宫腔粘连分离术后冻融胚胎移植周期轻刮子宫内膜对改善妊娠结局的影响研究［J］. 中国实用妇科与产科杂志， 2017，33（1）：114-117.
19	王玉清，刘竞京，郭子珍，等. 宫腔粘连分离术后行鲜胚移植活产的影响因素分析［J］. 现代妇产科进展， 2022，31（1）：11-14. doi:10.13283/j.cnki.xdfckjz.2022.01.002 doi: 10.13283/j.cnki.xdfckjz.2022.01.002
20	段华，夏恩兰，王素敏，等. 宫腔粘连临床诊疗中国专家共识［J］. 中华妇产科杂志，2015，50（12）：881-887.
21	CHEN L， ZHANG H， WANG Q，et al. Reproductive outcomes in patients with intrauterine adhesions following hysteroscopic adhesiolysis： experience from the largest women's hospital in China［J］. J Minim Invasive Gynecol，2017，24（2）：299-304. doi:10.1016/j.jmig.2016.10.018 doi: 10.1016/j.jmig.2016.10.018
22	EVANS H E A， YOUNG S L. Endometrial receptivity and intrauterine adhesive disease［J］. Semin Reprod Med， 2014，32（5）：392-401. doi:10.1055/s-0034-1376358 doi: 10.1055/s-0034-1376358
23	KAMATH M S， CHITTAWAR P B， KIRUBAKARAN R，et al. Use of granulocyte-colony stimulating factor in assisted reproductive technology： A systematic review and meta-analysis［J］. Eur J Obstet Gynecol Reprod Biol，2017，214：16-24. doi:10.1016/j.ejogrb.2017.04.022 doi: 10.1016/j.ejogrb.2017.04.022
24	MANSOUR R， TAWAB N， KAMAL O，et al. Intrauterine injection of human chorionic gonadotropin before embryo transfer significantly improves the implantation and pregnancy rates in in vitro fertilization/intracytoplasmic sperm injection： a prospective randomized study［J］. Fertil Steril， 2011，96（6）：1370-1374. doi:10.1016/j.fertnstert.2011.09.044 doi: 10.1016/j.fertnstert.2011.09.044
25	CUI N， LI A M， LUO Z Y，et al. Effects of growth hormone on pregnancy rates of patients with thin endometrium［J］. J Endocrinol Invest，2019，42（1）：27-35. doi:10.1007/s40618-018-0877-1 doi: 10.1007/s40618-018-0877-1
26	SHREYA P， SANDHYA P， TANMAY T. Recent advancement in the management of intrauterine adhesions using stem cell therapy： a review article［J］. Cureus， 2023，15（8）：e43553.

项目	单囊胚移植组（n = 182）	双囊胚移植组（n = 93）	t/χ²值	P值
年龄/岁	31.10 ± 2.66	30.77 ± 2.83	0.278	0.349
不孕年限/年	2.43 ± 1.64	3.03 ± 2.13	< 0.001	0.019
AFS预后评分/分	5.13 ± 2.25	5.72 ± 2.19	0.862	0.039
转化日子宫内膜厚度/mm	8.46 ± 1.56	8.37 ± 1.56	0.877	0.653
优胚率/%	90.66（165/182）	46.24（86/186）	83.711	< 0.001
自然周期比率/%	7.14（13/182）	11.83（11/93）	1.696	0.193
促排卵周期比率/%	22.53（41/182）	30.11（28/93）	1.882	0.170
激素替代周期比率/%	46.15（84/182）	39.78（37/93）	1.013	0.314
降调节激素替代周期比率/%	24.18（44/182）	18.28（17/93）	1.240	0.266

项目	单囊胚移植组（n = 182）	双囊胚移植组（n = 93）	t/χ²值	P值
种植率/%	50.00（91/182）	34.41（64/186）	9.173	0.002
临床妊娠率/%	50.00（91/182）	52.69（49/93）	0.178	0.673
多胎率/%	1.33（1/75）	28.57（10/35）	19.672	< 0.001
流产率/%	17.58（16/91）	28.57（14/49）	2.284	0.131
早产率/%	17.33（13/75）	20.00（7/35）	0.114	0.736
分娩孕周/周	39.09 ± 1.45	38.00 ± 3.32	0.748	0.649
活婴体质量/g	3 236.84 ± 565.35	2 976.44 ± 692.79	0.336	0.026
剖宫产率/%	73.33（55/75）	74.29（26/35）	0.011	0.916

影响因素	OR	95%CI	P值
年龄	0.928	0.844 ~ 1.019	0.117
不孕年限	1.109	0.965 ~ 1.276	0.146
转化日子宫内膜厚度	1.153	0.953 ~ 1.394	0.142
移植胚胎总数目	1.131	0.655 ~ 1.951	0.659
移植优质胚胎数目	2.376	1.403 ~ 4.022	0.001
AFS 评分	0.873	0.766 ~ 0.996	0.044

[1]	Yuying HU,Jinming ZHU,Jie LIU,Yawen PAN,Qian ZHANG,Jinqiu FENG. Expression and significance of miR⁃223⁃3p in serum of pregnant women with preterm premature rupture of membranes [J]. The Journal of Practical Medicine, 2024, 40(9): 1275-1279.
[2]	Qingqing WANG,Jie DING,Haiwen LI,Zhijian DONG,Yiying WANG,Siqi LIU,Guoji CHANG,Lijuan HUA,Huayi CHEN,Shenghao LI,Yongrui. YANG. Analysis of factors influencing short⁃term adverse clinical outcome in cirrhotic patients with grade 2/3 ascites [J]. The Journal of Practical Medicine, 2024, 40(8): 1114-1120.
[3]	Ling XIAO,Chunlei GAO,Wei GUO,Ning WANG,Xuan ZHANG,Ming. LIU. Codonopsis polysaccharide protected LPS⁃induced acute lung injury by inhibiting MAPK/NF⁃κB signaling pathway in mice [J]. The Journal of Practical Medicine, 2024, 40(7): 948-954.
[4]	Xiaotong LIU,Xianhua SU,Zhijun XIN,Fengqiong GAO,Jiayi FENG,Tongxia. XIA. Risk factors of postoperative complications in patients with spinal tuberculosis and the predictive value of prognostic nutritional index [J]. The Journal of Practical Medicine, 2024, 40(7): 972-978.
[5]	Changzhi GUO,Tao SUN,Shuman HAN,Lingxiang WANG,Mengjing. NIU. Risk factors of peripheral infections of knee joint tumor prosthesis and predictive value of serum D⁃dimer and TLR2 [J]. The Journal of Practical Medicine, 2024, 40(6): 814-819.
[6]	Xilin WANG,Chanjuan YANG,Daomeng. CHENG. Construction of a nomogram prediction model for aggressive behavior in patients with bipolar disorder [J]. The Journal of Practical Medicine, 2024, 40(5): 677-681.
[7]	Li LI,Lin. TANG. Analysis of influencing factors of non⁃suicidal self⁃injury behavior and motivation in adult patients with depression [J]. The Journal of Practical Medicine, 2024, 40(4): 466-470.
[8]	Huiqun WANG,Chao YE,Chao XU,Si CHEN,Kaiguang ZHANG,Mei. XIAO. A 5⁃year follow⁃up study of rebleeding after endoscopic treatment of esophageal gastric varices rebleeding associated with liver cirrhosis [J]. The Journal of Practical Medicine, 2024, 40(22): 3155-3159.
[9]	Yuncan WANG,Guangyun CAO,Haibo WU,Na WANG. The relationship between internal carotid artery wall shear stress and carotid plaque neovascularization was evaluated by carotid color ultrasound [J]. The Journal of Practical Medicine, 2024, 40(22): 3232-3237.
[10]	Shijun LUO,Lizi ZHANG,Dunjin. CHEN. Diagnosis， prevention and treatment of placenta accreta spectrum with non⁃traumatic factors [J]. The Journal of Practical Medicine, 2024, 40(21): 2971-2975.
[11]	Lili TANG,Xueming LI,Liming LEI,Xiaodong ZENG,Yun LING,Qiongyu LIN,Sumin. ZHU. Risk factors for prolonged ICU stay after surgery in patients with infective endocarditis [J]. The Journal of Practical Medicine, 2024, 40(20): 2854-2859.
[12]	Bin ZHANG,Wei HU,Rongzhen TAN,Panpan YANG,Jun HU,Zhong YUAN,Gongtao. JIANG. Effects of Yishen Huayu Xugu prescription combined with Dixumab on IL-6， β-CTX and bone mineral density in elderly patients operated for osteoporotic lumbar vertebral compression fractures [J]. The Journal of Practical Medicine, 2024, 40(19): 2766-2771.
[13]	Kun WANG,Xiaomei. CAO. A review of studies on chronic obstructive pulmonary disease complicated with osteoporosis [J]. The Journal of Practical Medicine, 2024, 40(19): 2796-2800.
[14]	Xianghong CHEN,Xiumin CHEN,Yingyan ZHOU,Li LI,Zhenxiong. XU. Advancements in the investigation of cardiovascular risk associated with idiopathic inflammatory myopathy [J]. The Journal of Practical Medicine, 2024, 40(19): 2801-2805.
[15]	Yanping WANG,Wenhui GAO,Yanting WU,Jun YANG,Yi ZHOU,Xiaoshun. JIAN. Analysis of influencing factors on clinical efficacy of neutropenia with febrile neutropenia in tumor patients [J]. The Journal of Practical Medicine, 2024, 40(18): 2597-2601.

Strategy for frozen⁃thawed cycle blastocyst transfer after hysteroscopic adhesiolysis

RichHTML

PDF (PC)

Knowledge

Abstract

Cite this article

share this article

Figures/Tables 3

References 26

Related Articles 15

Recommended Articles

Metrics

Comments