【摘要】 目的 探讨子宫腺肌病综合治疗后对体外受精/卵胞浆内单精子注射-冻融胚胎移植(IVF/ICSI-FET)妊娠结局的影响，并分析其可能的影响因素。方法 回顾性分析2018年1月—2020年10月在浙江大学医学院附属邵逸夫医院生殖中心进行IVF/ICSI后行FET的患者资料。以年龄为匹配标准，按1∶2倾向性评分方式匹配子宫腺肌病和单纯输卵管性不孕患者，分析两组妊娠率、胚胎种植率、流产率及活产率。再将子宫腺肌病组按照不同的治疗方案分为病灶切除手术组和未手术组(GnRHa降调节≥3个月组和GnRHa降调节<3个月组)，比较不同处理后的妊娠结局。结果 共纳入153例子宫腺肌病合并不孕症患者作为子宫腺肌病组，306例单纯输卵管性不孕患者为对照组。两组间的不孕年限等基本情况和获卵数等治疗情况比较差异均无统计学意义(均P > 0.05)。两组临床妊娠率(53.6%vs. 47.4%)、流产率(22.0%vs. 20.7%)、继续妊娠率(44.4%vs.38.9%)、胚胎种植率(36.0%vs. 34.5%)、活产率(41.8%vs. 37.6%)及早产率(12.2%vs. 19.3%)比较，差异均无统计学意义(χ~2=1.573、0.050、1.304、1.761、0.774及1.903，均P > 0.05)。子宫腺肌病组多胎妊娠率低于对照组(7.8%vs.23.4%)，差异有统计学意义(χ~2=9.389,P<0.05)。logistic二元回归分析结果显示，年龄是影响临床妊娠率和活产率的独立影响因素(OR=0.934、1.070，均P<0.05)。子宫腺肌病组内行子宫腺肌病病灶切除手术或不同时间GnRHa预处理患者的临床妊娠率、胚胎种植率、流产率及活产率差异均无统计学意义(均P>0.05)。结论 对于不同严重程度的子宫腺肌病患者经过注射GnRHa或病灶切除手术预处理后，IVF/ICSI-FET妊娠结局能达到与输卵管因素不孕患者的相当水平。更多还原

【Abstract】 Objective To investigate the impact of comprehensive treatment for adenomyosis on in vitro fertilization/intracytoplasmic sperm injection-frozen embryo transfer( IVF/ICSI-FET) pregnancy outcomes and analyze potential influencing factors. Methods A retrospective analysis was conducted on data from patients who underwent IVF/ICSI followed by FET at the Reproductive Center of the Affiliated Sir Run Run Shaw Hospital,Zhejiang University School of Medicine,between January 2018 and October 2020. Using age as a matching criterion,patients with adenomyosis were propensity score-matched( 1 ∶ 2) to patients with tubal infertility. Clinical pregnancy rate,implantation rate,miscarriage rate,and live birth rate were compared between the two groups. The adenomyosis group was further stratified into a surgical resection group and a non-surgical group( GnRHa down-regulation ≥3 months and GnRHa down-regulation<3 months) to compare pregnancy outcomes after different treatments. Results A total of 153 patients with adenomyosis and infertility were included in the adenomyosis group,and 306 patients with tubal infertility served as the control group. There were no statistically significant differences in baseline characteristics,such as infertility duration,and treatment parameters,such as retrieved oocyte number,between the two groups( all P>0. 05).There were no statistically significant differences between the two groups in clinical pregnancy rate( 53. 6% vs. 47. 4%),miscarriage rate( 22. 0% vs. 20. 7%),ongoing pregnancy rate( 44. 4% vs. 38. 9%),implantation rate( 36. 0% vs. 34. 5%),live birth rate( 41. 8% vs. 37. 6%),and preterm birth rate( 12. 2% vs. 19. 3%)( χ~2= 1. 573,0. 050,1. 304,1. 761,0. 774,1. 903,all P>0. 05).The multiple pregnancy rate in the adenomyosis group was significantly lower than that in the control group( 7. 8% vs. 23. 4%)( χ~2= 9. 389,P<0. 05).Binary logistic regression analysis showed that age was an independent influencing factor for clinical pregnancy rate and live birth rate( OR = 0. 934,1. 070,all P<0. 05).There were no statistically significant differences in clinical pregnancy rate,implantation rate,miscarriage rate,and live birth rate among patients in the adenomyosis group who underwent adenomyosis resection surgery or different durations of GnRHa pretreatment( all P> 0. 05). Conclusion After GnRHa injection or surgical resection pretreatment,IVF/ICSI-FET pregnancy outcomes in patients with adenomyosis of varying severity reached comparable levels to those of patients with tubal factor infertility.更多还原