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作者	单位	E-mail
马　玲	武汉大学中南医院生殖医学中心武汉湖北 430071	maling@znhospital.cn
洪志丹	武汉大学中南医院生殖医学中心武汉湖北 430071
王　燕	武汉大学中南医院生殖医学中心武汉湖北 430071
毛艳红	武汉大学中南医院生殖医学中心武汉湖北 430071
周　春	武汉大学中南医院生殖医学中心武汉湖北 430071

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中文摘要:

摘要目的：评价内膜厚度及内膜形态对于体外受精-胚胎移植中冷冻胚胎解冻复苏移植的临床妊娠结局的预测价值。方法：回顾性分析1521个冷冻胚胎解冻复苏移植周期，将患者按子宫内膜厚度分为4组，子宫内膜≤6 mm、6.1-8.0 mm、8.0-12 mm、>12.0 mm，根据子宫内膜形态分为A型内膜、B型内膜、C型内膜。分别比较不同内膜厚度分组及不同内膜形态分组患者的年龄，移植胚胎数目、内膜准备方案构成比、移植胚胎类型(卵裂期胚胎、囊胚)构成比及各组间的临床妊娠率和活产率。采用ROC曲线分析子宫内膜厚度、形态对临床妊娠结局的预测价值。使用逐步回归分析内膜厚度、形态、年龄及移植胚胎类型与妊娠结局的相关性。结果：纳入1521个解冻复苏周期中按内膜厚度分为4组，各组周期数分别为96周期、454周期、893周期、78周期，各组间平均年龄分别为34.1±5.5岁、33.3 ± 5.4岁、32.5± 5.2岁、33.7± 6.0岁(P<0.05)。内膜厚度≤6 mm组临床妊娠率为31.3%，子宫内膜≤6 mm、6.1-8.0 mm、8.0-12 mm、>12.0 mm组临床妊娠率分别为48.5%、51.8%、47.4%(P<0.05)。子宫内膜≤6 mm、6.1-8.0 mm、8.0-12 mm、>12.0 mm组间活产率分别为18.8%、37.7%、44.6%、39.7%(P<0.05)。A型、B型及C型内膜组周期数分别为920周期、189周期及412周期，三组间平均年龄分别为32.3±5.1、33.0±5.7、34.2±5.5岁(P<0.05)。A型/B型及C型内膜组临床妊娠率分别为51.2%、46.6%及46.4%，三组间活产率分别为42.1%、36.0%及37.1%，三组间差异无统计学意义(P>0.05)。子宫内膜厚度ROC曲线下面积为0.534(95%可信区间0.505-0.564)，子宫内膜形态ROC曲线下面积为0.526(0.476-0.955)。逐步回归分析纳入内膜厚度、内膜形态、年龄、胚胎类型4个可变量，女方年龄(OR=0.929，P<0.001),移植胚胎中囊胚比例(OR=1.595，P<0.001)与临床妊娠率明显相关，内膜厚度(OR=1.054，P=0.05)及内膜形态(OR=0.864)与临床妊娠率无相关性。结论：虽然子宫内膜薄临床妊娠率下降，但是子宫内膜厚度与内膜形态不能够预测体外受精-胚胎移植解冻复苏周期临床妊娠率，患者年龄以及移植胚胎的发育潜能才是预测临床妊娠率的参考指标。

英文摘要:

ABSTRACT Objective: To evaluate the predictive value of endometrial patterns and endometrial thickness on clinical pregnancy outcome during frozen embryo transfer. Methods: A retrospective analysis was conducted in 1521 frozen-thawed embryo transfer cycles from Wuhan University Zhongnan Hospital between 2013 and 2016. According to the different endometrial thickness, the patients were divided into 4 groups: ≤6 mm, 6.1-8.0 mm, 8.0-12 mm, >12.0 mm. According to the endometrial patterns, the patients were divided into 3 groups: type A, B, C. Ages, numbers of embryos transferred per cycle、methods of preparing endometrium, ratio of blastocysts, clinical pregnancy rate and live birth rate were measured. ROC curve was used to analyze the predictive value on the outcomes of pregnancy. Stepwise regression analysis was used to analyze the relationship between endometrial thickness, patterns, age, the ratio of blastocysts and pregnancy rate. Results: 1521 cycles were divided into 4 groups according to endometrial thickness. There are 96 cycles, 454 cycles、893cycles and 78 cycles in four groups. The mean age of the 4 groups is 34.1±5.5 years, 33.3 ± 5.4 years, 32.5± 5.2 years, 33.7± 6.0 years(P<0.01). The pregnancy rate was 31.3% with 6mm or less endometrial thickness. The pregnancy rate was 48.5%, 51.8% and 47.4%(P<0.05) The live birth rate in 4 groups were as follows: 18.8%, 37.7%, 44.6%, 39.7%(P<0.05). All the cycles were divided into 3 groups according to endometrial patterns, type A, B, C. There are 920 cycles, 189 cycles and 412cycles in 3 groups. The average age of 3 groups were as follows: 32.3±5.1years, 33.0±5.7 years, 34.2±5.5 years(P<0.05). The pregnancy rate and the live birth rate in 3 type endometrial patterns showed no significant difference(P>0.05). The area under ROC curve was 0.534(95% C I 0.505-0.564) with endometrial thickness. The area under ROC curve was 0.526(0.476-0.955) with endometrial pattern. There is no association with endometrial thickness(OR=1.054, P=0.05), endometrial patterns(OR=0.864) and pregnancy rate after adjusting for confounders such as age(OR=0.929, P<0.001), the ratio of blastocysts(OR=1.595, P<0.001) with stepwise regression analyze. Conclusion: Although the pregnancy rate was decreased in less endometrial thickness, but endometrial thickness and patterns can't predict the clinical pregnancy rate. Age and the potential to form the blastocyst are the indicators for predicting clinical pregnancy rate.

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