【摘要】 目的 探讨宫腔粘连分离术后胚胎移植助孕活产的预后因素。方法 回顾性分析宫腔镜检查诊断宫腔粘连(intrauterine adhesion, IUA)并行宫腔粘连分离术，于2018年1月～2020年12月行胚胎移植共643例资料。比较术后治疗方案及胚胎移植后的妊娠结局。以活产率为主要终点指标，并对相关因素进行回归分析，探讨影响活产的因素。结果 643例中，宫腔粘连为轻度20.5%(132/643),中度63.6%(409/643),重度15.9%(102/643)。宫腔镜术后至第一周期胚胎移植的中位时间为126(73,225)d。临床妊娠率32.7%(210/643),活产率24.7%(159/643)。logistic回归分析显示，年龄(OR=0.926,95%CI:0.880～0.974,P=0.003)和移植日子宫内膜厚度(OR=1.188,95%CI:1.030～1.370,P=0.018)是活产的预后因素。轻度粘连组和中度粘连组中年龄增大活产率显著降低(P=0.004、0.018),重度粘连组随着年龄增加活产率降低，但差异无显著性(P=0.526)。术后雌激素用量、人工周期数目、手术与移植间隔时间、新鲜或冻融胚胎移植、移植的胚胎类型对活产无显著影响。结论 年龄和移植日子宫内膜厚度是宫腔粘连术后胚胎移植活产的预后因素。宫腔粘连术后新鲜胚胎移植或冻融胚胎移植、术后至胚胎移植间隔时间对活产结局无显著影响。更多还原

【Abstract】 Objective To investigate the clinical factors affecting live birth rate in patients who underwent hysteroscopic adhesiolysis and subsequent embryo transfer. Methods A total of 643 patients who had undergone hysteroscopic surgery to remove various degrees of intrauterine adhesion(IUA) and subsequently received embryo transfer between January 2018 and December 2020 were retrospectively analyzed. Postoperative treatment regimens and pregnancy outcomes after embryo transfer were collected. The primary endpoint was live birth rate. A multivariate logistic regression analysis was performed to further investigate the factors affecting pregnancy outcomes. Results Among the 643 IUA patients, 20.5%(132/643) patients were diagnosed as having mild IUA, 63.6%(409/643) patients moderate IUA, and 15.9%(102/643) patients severe IUA. The median time from hysteroscopy to the first cycle of embryo transfer was 126(73, 225) d. The clinical pregnancy rate was 32.7%(210/643) and the live birth rate was 24.7%(159/643). Logistic regression analysis found that age(OR=0.926, 95% CI: 0.880-0.974, P=0.003)and endometrial thickness on the day of transplantation(OR=1.188, 95% CI: 1.030-1.370, P=0.018) were prognostic factors of live birth. The live birth rate significantly decreased with age in the mild and moderate adhesion groups(P=0.004 and 0.018), while in the severe adhesion group, the live birth rate decreased with age, but the difference was not significant(P=0.526). Postoperative estrogen dosage, number of artificial cycles, interval between hysteroscopy and transplantation, fresh or frozen-thawed embryo transfer, and type of embryo transferred had no significant impact on live birth. Conclusions Maternal age and endometrial thickness on the day of transplantation are the most important predictors of live birth in patients undergoing embryo transfer after hysteroscopic adhesiolysis. Fresh or frozen-thawed embryo transfer after surgery and the interval between hysteroscopy and transplantation do not affect the live birth rate.更多还原