合并子宫内膜息肉不孕症患者息肉切除术后行辅助生殖助孕活产率的影响因素分析
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摘要
目的分析合并子宫内膜息肉不孕症患者经宫腔镜子宫内膜息肉电切术(TCRP)后行体外受精/卵胞浆内单精子注射(IVF/ICSI)助孕治疗活产率的影响因素。方法回顾性分析我中心2015年6月至2016年12月诊断为子宫内膜息肉(EPs)不孕症患者(496例)的临床资料。纳入患者行TCRP术后进一步接受IVF/ICSI助孕治疗,根据最后的活产情况将患者分为两组:无活产组(n=250)和活产组(n=246),比较两组患者之间各项临床指标的差异,应用多元回归模型确定活产率的独立影响因素。结果纳入的496例患者中246例获得活产,总活产率为49.6%。活产组患者的平均年龄、体重指数(BMI)及术后恢复时间均显著小于无活产组(P<0.05)。IVF/ICSI治疗期间,无活产组的子宫内膜厚度显著薄于活产组(P<0.05)。行多元回归分析发现,年龄、BMI、术后恢复时间和HCG日子宫内膜厚度可能为影响TCRP术后活产率的独立因素(P<0.05),且宫腔恢复时间与HCG日子宫内膜厚度呈负相关(P<0.05)。其他相关参数包括息肉的位置和数量、宫腔恢复至胚胎移植间隔时间则与活产率无显著相关(P>0.05)。结论年龄、BMI、术后恢复时间和HCG日子宫内膜厚度可能是影响TCRP术后活产率的独立因素,因此,对于不孕症合并子宫内膜息肉需行手术治疗的患者,临床上应关注患者个体情况包括年龄、BMI等因素进行个体化治疗,以促进术后宫腔恢复,有利于提高下一步IVF/ICSI活产。
Objective:To identify the influencing factors of live birth in infertile women of IVF/ICSI treatment after hysteroscopic polypectomy.Methods:The data of 496 infertile patients who underwent IVF/ICSI treatment after hysteroscopic polypectomy with a loop bipolar electrode were retrospectively analyzed.The patients were divided into two groups:non-live birth group(n=250)and live birth group(n=246).The demographic and clinical parameters were compared between the two groups.Multivariate regression model was used to identify independent predictive factors for live birth.Results:In 496 patients,the live birth rate was 49.6%(n=246).The mean age,body mass index(BMI)and postoperative recovery time of the live birth group were significantly lower than those of the non-live birth group(P<0.05).Multiple regression analysis showed that age,BMI,postoperative recovery time and endometrial thickness on HCG day were the independent factors affecting the live birth rate after hysteroscopic polypectomy(P<0.05).Moreover,the recovery time of uterine cavity were significantly negatively correlated with the endometrium thickness on HCG day(P<0.05).The other factors including the location & number of polyps,and time interval from uterine recovery to embryo transfer were not associated with live birth(P>0.05).Conclusions:Age,BMI,recovery time and endometrial thickness on HCG days are independent factors affecting the live birth rate after hysteroscopic polypectomy.Therefore,the clinicians should pay attention to individual conditions including age,BMI and other factors in order to promote postoperative uterine cavity recovery and enhance the live birth rate of IVF/ICSI in the infertility patients with endometrial polyps.
Objective:To identify the influencing factors of live birth in infertile women of IVF/ICSI treatment after hysteroscopic polypectomy.Methods:The data of 496 infertile patients who underwent IVF/ICSI treatment after hysteroscopic polypectomy with a loop bipolar electrode were retrospectively analyzed.The patients were divided into two groups:non-live birth group(n=250)and live birth group(n=246).The demographic and clinical parameters were compared between the two groups.Multivariate regression model was used to identify independent predictive factors for live birth.Results:In 496 patients,the live birth rate was 49.6%(n=246).The mean age,body mass index(BMI)and postoperative recovery time of the live birth group were significantly lower than those of the non-live birth group(P<0.05).Multiple regression analysis showed that age,BMI,postoperative recovery time and endometrial thickness on HCG day were the independent factors affecting the live birth rate after hysteroscopic polypectomy(P<0.05).Moreover,the recovery time of uterine cavity were significantly negatively correlated with the endometrium thickness on HCG day(P<0.05).The other factors including the location & number of polyps,and time interval from uterine recovery to embryo transfer were not associated with live birth(P>0.05).Conclusions:Age,BMI,recovery time and endometrial thickness on HCG days are independent factors affecting the live birth rate after hysteroscopic polypectomy.Therefore,the clinicians should pay attention to individual conditions including age,BMI and other factors in order to promote postoperative uterine cavity recovery and enhance the live birth rate of IVF/ICSI in the infertility patients with endometrial polyps.
引文
[1]Americcan Association of Gynecologic Laparoscopists.AAGL practice report:practice guidelines for the diagnosis and management of endometrial polyps[J].J Minim Invasive Gynecol,2012,19:3-10.
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[5]Hosseini MA,Ebrahimi N,Mahdavi A,et al.Hysteroscopy in patients with repeated implantation failure improves the outcome of assisted reproductive technology in fresh and frozen cycles[J].J Obstet Gynaecol Res,2014,40:1324-1330.
[6]Elias RT,Pereira N,Karipcin FS,et al.Impact of newly diagnosed endometrial polyps during controlled ovarian hyperstimulation on in vitro fertilization outcomes[J].JMinim Invasive Gynecol,2015,22:590-594.
[7]Pérez-Medina T,Bajo-Arenas J,Salazar F,et al.Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination:a prospective randomized study[J].Hum Reprod,2005,20:1632-1635.
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[9]Yanaihara A,Yorimitsu T,Motoyama H,et al.Location of endometrial polyp and pregnancy rate in infertility patients[J].Fertil Steril,2008,90:180-182.
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[11]Richlin SS,Ramachandran S,Shanti A,et al.Glycodelin levels in uterine flushings and in plasma of patients with leiomyomas and polyps:implications for implantation[J].Hum Reprod,2002,17:2742-2747.
[12]Afifi K,Anand S,Nallapeta S,et al.Management of endometrial polyps in subfertile women:a systematic review[J].Eur J Obstet Gynecol Reprod Biol,2010,151:117-121.
[13]Broekmans FJ,Kwee J,Hendriks DJ,et al.A systematic review of tests predicting ovarian reserve and IVF outcome[J].Hum Reprod Update,2006,12:685-718.
[14]Zhang X,Chen CH,Confino E,et al.Increased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilization-embryo transfer[J].Fertil Steril,2005,83:336-340.
[15]Moffat R,Beutler S,Sch9tzau A,et al.Endometrial thickness influences neonatal birth weight in pregnancies with obstetric complications achieved after fresh IVF-ICSI cycles[J].Arch Gynecol Obstet,2017,296:115-122.
[16]Kasius A,Smit JG,Torrance HL,et al.Endometrial thickness and pregnancy rates after IVF:a systematic review and meta-analysis[J].Hum Reprod Update,2014,20:530-541.
[17]Ahmadi F,Akhbari F,Zamani M,et al.Value of endometrial echo pattern at HCG administration day in predicting IVFoutcome[J].Arch Iran Med,2017,20:101-104.
[18]Wang L,Qiao J,Li R,et al.Role of endometrial blood flow assessment with color Doppler energy in predicting pregnancy outcome of IVF-ET cycles[J].Reprod Biol Endocrinol,2010,8:122.
[19]Zhu L,Che H S,Xiao L,et al.Uterine peristalsis before embryo transfer affects the chance of clinical pregnancy in fresh and frozen-thawed embryo transfer cycles[J].Hum Reprod,2014,29:1238-1243.
[20]Pampalona JR,Bastos MD,Moreno GM,et al.A comparison of hysteroscopic mechanical tissue removal with bipolar electrical resection for the management of endometrial polyps in an ambulatory care setting:preliminary results[J].J Mini Invasive Gynecol,2015,22:439-445.
[21]韩正枝.孕激素辅助宫腔镜子宫内膜息肉切除术治疗子宫内膜息肉的临床疗效及对子宫内膜血管内生长因子表达的影响[J].贵州医药,2017,41:294-296.
[22]Eryilmaz OG,Gulerman C,Sarikaya E,et al.Appropriate interval between endometrial polyp resection and the proceeding IVF start[J].Arch Gynecol Obstet,2012,285:1753-1757.
[23]Pereira N,Petrini AC,Lekovich JP,et al.Surgical management of endometrial polyps in infertile women:a comprehensive review[J].Surg Res Pract,2015,2015:914390.doi:10.1155/2015/914390.
[24]Yang JH,Yang PK,Chen MJ,et al.Management of endometrial polyps incidentally diagnosed during IVF:a casecontrol study[J/OL].Reprod Biomed Online,2017,34:285-290.
[25]Li F,Wei S,Yang S,et al.Post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps[J].Pak J Med Sci,2018,34:1267-1271.
[26]Yang JH,Chen CD,Chen SU,et al.Factors influencing the recurrence potential of benign endometrial polyps after hysteroscopic polypectomy[J/OL].PLoS One,2015,10:e0144857.
[2]Tanos V,Berry KE,Seikkula J,et al.The management of polyps in female reproductive organs[J].Int J Surg,2017,43:7-16.
[3]Kodaman PH.Hysteroscopic polypectomy for women undergoing IVF treatment:when is it necessary[J].Curr Opin Obstet Gynecol,2016,28:184-190.
[4]Zhu H,Fu J,Lei H,et al.Evaluation of transvaginal sonography in detecting endometrial polyps and the pregnancy outcome following hysteroscopic polypectomy in infertile women[J].Exp Ther Med,2016,12:1196-1200.
[5]Hosseini MA,Ebrahimi N,Mahdavi A,et al.Hysteroscopy in patients with repeated implantation failure improves the outcome of assisted reproductive technology in fresh and frozen cycles[J].J Obstet Gynaecol Res,2014,40:1324-1330.
[6]Elias RT,Pereira N,Karipcin FS,et al.Impact of newly diagnosed endometrial polyps during controlled ovarian hyperstimulation on in vitro fertilization outcomes[J].JMinim Invasive Gynecol,2015,22:590-594.
[7]Pérez-Medina T,Bajo-Arenas J,Salazar F,et al.Endometrial polyps and their implication in the pregnancy rates of patients undergoing intrauterine insemination:a prospective randomized study[J].Hum Reprod,2005,20:1632-1635.
[8]Kogan L,Dior U,Chill H,et al.Operative hysteroscopy for treatment of intrauterine pathologies does not interfere with later endometrial development in patients undergoing in vitro fertilization[J].Arch Gynecol Obstet,2016,293:1097-1100.
[9]Yanaihara A,Yorimitsu T,Motoyama H,et al.Location of endometrial polyp and pregnancy rate in infertility patients[J].Fertil Steril,2008,90:180-182.
[10]马媛,李懋,梁新新,等.不同位置子宫内膜息肉TCRP术后对IVF/ICSI妊娠结局的影响[J].生殖医学杂志,2017,26:1206-1211.
[11]Richlin SS,Ramachandran S,Shanti A,et al.Glycodelin levels in uterine flushings and in plasma of patients with leiomyomas and polyps:implications for implantation[J].Hum Reprod,2002,17:2742-2747.
[12]Afifi K,Anand S,Nallapeta S,et al.Management of endometrial polyps in subfertile women:a systematic review[J].Eur J Obstet Gynecol Reprod Biol,2010,151:117-121.
[13]Broekmans FJ,Kwee J,Hendriks DJ,et al.A systematic review of tests predicting ovarian reserve and IVF outcome[J].Hum Reprod Update,2006,12:685-718.
[14]Zhang X,Chen CH,Confino E,et al.Increased endometrial thickness is associated with improved treatment outcome for selected patients undergoing in vitro fertilization-embryo transfer[J].Fertil Steril,2005,83:336-340.
[15]Moffat R,Beutler S,Sch9tzau A,et al.Endometrial thickness influences neonatal birth weight in pregnancies with obstetric complications achieved after fresh IVF-ICSI cycles[J].Arch Gynecol Obstet,2017,296:115-122.
[16]Kasius A,Smit JG,Torrance HL,et al.Endometrial thickness and pregnancy rates after IVF:a systematic review and meta-analysis[J].Hum Reprod Update,2014,20:530-541.
[17]Ahmadi F,Akhbari F,Zamani M,et al.Value of endometrial echo pattern at HCG administration day in predicting IVFoutcome[J].Arch Iran Med,2017,20:101-104.
[18]Wang L,Qiao J,Li R,et al.Role of endometrial blood flow assessment with color Doppler energy in predicting pregnancy outcome of IVF-ET cycles[J].Reprod Biol Endocrinol,2010,8:122.
[19]Zhu L,Che H S,Xiao L,et al.Uterine peristalsis before embryo transfer affects the chance of clinical pregnancy in fresh and frozen-thawed embryo transfer cycles[J].Hum Reprod,2014,29:1238-1243.
[20]Pampalona JR,Bastos MD,Moreno GM,et al.A comparison of hysteroscopic mechanical tissue removal with bipolar electrical resection for the management of endometrial polyps in an ambulatory care setting:preliminary results[J].J Mini Invasive Gynecol,2015,22:439-445.
[21]韩正枝.孕激素辅助宫腔镜子宫内膜息肉切除术治疗子宫内膜息肉的临床疗效及对子宫内膜血管内生长因子表达的影响[J].贵州医药,2017,41:294-296.
[22]Eryilmaz OG,Gulerman C,Sarikaya E,et al.Appropriate interval between endometrial polyp resection and the proceeding IVF start[J].Arch Gynecol Obstet,2012,285:1753-1757.
[23]Pereira N,Petrini AC,Lekovich JP,et al.Surgical management of endometrial polyps in infertile women:a comprehensive review[J].Surg Res Pract,2015,2015:914390.doi:10.1155/2015/914390.
[24]Yang JH,Yang PK,Chen MJ,et al.Management of endometrial polyps incidentally diagnosed during IVF:a casecontrol study[J/OL].Reprod Biomed Online,2017,34:285-290.
[25]Li F,Wei S,Yang S,et al.Post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps[J].Pak J Med Sci,2018,34:1267-1271.
[26]Yang JH,Chen CD,Chen SU,et al.Factors influencing the recurrence potential of benign endometrial polyps after hysteroscopic polypectomy[J/OL].PLoS One,2015,10:e0144857.
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