三维超声参数积分评估人工授精妊娠结局的价值研究
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摘要
目的:探讨三维超声参数量化积分对子宫内膜容受性和妊娠结局的评估预测价值。方法:经阴道三维超声对216例自然周期夫精人工授精(AIH)患者行子宫内膜形态学、血流动力学及容积血流参数等多项指标测量,选择有统计学意义的参数进行量化积分,比较超声参数积分较高组与较低组的妊娠结局。结果:正常妊娠组与未妊娠组的子宫内膜厚度比较,差异无统计学意义(P>0.05);两组患者的内膜容积、内膜形态、内膜蠕动波比较,差异均有统计学意义(P<0.05)。妊娠组的血流动力学参数[(搏动指数)PI、阻力指数(RI)、收缩峰与舒张末期血流速度比(S/D)]均低于未妊娠组(P<0.05)。两组的容积血流参数中血管化指数(VI)、血管化-血流指数(VFI)比较,差异无统计学意义(P>0.05);妊娠组的血流指数(FI)高于未妊娠组(P<0.05)。超声参数积分较高与较低者的临床妊娠率分别为62.96%(51/81)和21.93%(34/155),差异有统计学意义(P<0.05)。结论:经三维超声参数量化积分可用于辅助生殖技术中评测内膜容受性及妊娠结局。
Objective:To investigate the value of three-dimensional ultrasound parameters integration in the prediction of endometrial receptivity and pregnancy outcome.Methods:Two hundred and sixteen patients undergoing artificial insemination by husband for assisted reproductive treatment cycles were recruited for this study.Transvaginal 3D ultrasound examination was performed to determine endometrial thickness,endometrial volume,endometrial type,endometrial peristalsis,and hemodynamic parameters of endometrium and subendometrium.Ultrasound monitoring parameters integration were underwent by the related indicators of endometrium monitoring.The relationship between ultrasound monitoring parameters ratings and pregnancy outcome were observed.Results:There was no statistical difference in endometrial thickness between the normal pregnancy group and the non-pregnancy group(P>0.05).There were statistical differences in endometrial volume,endometrial morphology and endometrial peristatic wave between the two groups(P<0.05).Hemodynamic parameters(PI,RI,S/D) in the pregnancy group were lower than those in the non-pregnancy group(P<0.05).There were no significant differences between the two groups in the VI,VFI in the volume flow parameters(P>0.05).FI of pregnancy group was higher than that of non-pregnancy group(P<0.05).The clinical pregnancy rate of the group with higher ultrasound parameter score was 62.96%(51/81).The clinical pregnancy rate in the lower score group was 21.93%(34/155).The difference was statistically significant(P<0.05).Conclusions:The three-dimensional ultrasound parameters integration can be as a reliable indicator to assess endometrial receptivity and predict the pregnancy outcome.
Objective:To investigate the value of three-dimensional ultrasound parameters integration in the prediction of endometrial receptivity and pregnancy outcome.Methods:Two hundred and sixteen patients undergoing artificial insemination by husband for assisted reproductive treatment cycles were recruited for this study.Transvaginal 3D ultrasound examination was performed to determine endometrial thickness,endometrial volume,endometrial type,endometrial peristalsis,and hemodynamic parameters of endometrium and subendometrium.Ultrasound monitoring parameters integration were underwent by the related indicators of endometrium monitoring.The relationship between ultrasound monitoring parameters ratings and pregnancy outcome were observed.Results:There was no statistical difference in endometrial thickness between the normal pregnancy group and the non-pregnancy group(P>0.05).There were statistical differences in endometrial volume,endometrial morphology and endometrial peristatic wave between the two groups(P<0.05).Hemodynamic parameters(PI,RI,S/D) in the pregnancy group were lower than those in the non-pregnancy group(P<0.05).There were no significant differences between the two groups in the VI,VFI in the volume flow parameters(P>0.05).FI of pregnancy group was higher than that of non-pregnancy group(P<0.05).The clinical pregnancy rate of the group with higher ultrasound parameter score was 62.96%(51/81).The clinical pregnancy rate in the lower score group was 21.93%(34/155).The difference was statistically significant(P<0.05).Conclusions:The three-dimensional ultrasound parameters integration can be as a reliable indicator to assess endometrial receptivity and predict the pregnancy outcome.
引文
[1] Jing Z,Zhang Q,Li Y.The effect of endometrial thickness and pattern[J].Chin Foreign Med Res,2017,15(9):235-237
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[3] 陈淑霞,鄢曹鑫.不同超声参数在评估IVF-ET患者子宫内膜容受性中的价值[J].中华全科医学,2019,17(5):821-824.
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[7] 张奕文,李蓉.评估和改善子宫内膜容受性治疗反复种植失败的研究进展[J].中华生殖与避孕杂志,2017,37(9):754-758
[8] Riad ON.Assessment of endometrial receptivity using Doppler ultrasonography in infertile women undergoing intrauterine insemination[J].Gynecol Endocrinol,2014,30(1):70-73
[9] 于姣姣,陈玲,胡宾,等.经阴道三维超声评价子宫内膜容受性对体外受精-胚胎移植者妊娠结局的预测价值[J].山东医药,2017,52(26):60-62
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[12] 张宜生,周馥贞,应伟雯.三维超声测定子宫内膜容积预测IVF-ET结局[J].实用妇产科杂志,2006,21(6):375-377
[13] 王锦惠,于子芳,闫芳,等.经阴道二维及三维超声对体外受精- 胚胎移植子宫内膜容受性的评估价值[J/CD].中华医学超声杂志:电子版,2015,12(4):319-324
[14] Gonen Y,Casper RF,Jacobson W.Endometrial thickness and growth during ovarian stimulation:a possible predictor of implantation in in vitro fertilization[J].Fertil Steril,1989,52 (3):446-450
[15] Zhang T,Li Z,Ren X,et al.Endometrial thickness as a predictor of the reproductive outcomes in fresh and frozen embryo transfer cycles:a retrospective cohort study of 1512 IVF cycles with morphologically good-quality blastocyst[J].Med,2018,97(4):e9689
[16] Kuijsters NPM,Methorst WG,Kortenhorst MSQ,et al.Uterine peristalsis and fertility:current knowledge and future perspectives:a review and meta-analysis[J].ReprodBiomed Online,2017,35(1):50-71
[17] Prasad S,Goyal R,Kumar Y,et al.The relationship between uterine artery two-dimensional color doppler measurement and pregnancy outcome:a prospective observational study[J].J Reprod Infertil,2017,18(2):251-256
[18] Chien LW,Au HK,Chen PL,et al.Assessment of uterine receptivity by the endometrial-subendometrial blood flow distribution pattern in women undergoing in vitro fertilization-embryo transfer[J].Fertil Steril,2012,78(2):245-251
[19] Kupesic S,Bekavac I,Bjelos D,et al.Assessment of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasonography in patients underging in-vitro fertilization procedures[J].Ultrasound Med,2001,20(2):125-134
[20] Wang J,Xia F,Zhou Y,et al.Association between endometrial /subendometrial vasculature and embryo transfer outcome:a meta-analysis and subgroup analysis[J].JUltrasound Med,2018,37(1):149-163
[2] 梁靓.子宫内膜容受性的超声评估方法研究进展[J].中华生殖与避孕杂志,2015,35(12):873-878
[3] 陈淑霞,鄢曹鑫.不同超声参数在评估IVF-ET患者子宫内膜容受性中的价值[J].中华全科医学,2019,17(5):821-824.
[4] Miller PB,Parnell BA,Bushnell G,et al.Endometrial receptivity defects during IVF cycles with and without letrozole[J].Hum Reprod,2012,27(3):881-888
[5] Pop CM,Mihu D,Badea R.Role of contrast-enhanced ultrasound( CEUS) in the diagnosis of endometrial pathology[J].Clujul Med,2015,88(4):433-437
[6] Demura TA,Kogan EA,Zanozin AS,et al.The role of inherited thrombophilia and undifferentiated connective tissue dysplasia syndrome in the pathogenesis of female infertility:Aclinical and morphological study[J].Arkh Potal,2015,77(4):3-10
[7] 张奕文,李蓉.评估和改善子宫内膜容受性治疗反复种植失败的研究进展[J].中华生殖与避孕杂志,2017,37(9):754-758
[8] Riad ON.Assessment of endometrial receptivity using Doppler ultrasonography in infertile women undergoing intrauterine insemination[J].Gynecol Endocrinol,2014,30(1):70-73
[9] 于姣姣,陈玲,胡宾,等.经阴道三维超声评价子宫内膜容受性对体外受精-胚胎移植者妊娠结局的预测价值[J].山东医药,2017,52(26):60-62
[10] 何亚琼,杨静,张天杰,等.IVF/ICSI-ET中三维超声对子宫内膜容受性的评价价值[J].生殖与避孕,2015,35(9):618-625
[11] 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(4):530-541
[12] 张宜生,周馥贞,应伟雯.三维超声测定子宫内膜容积预测IVF-ET结局[J].实用妇产科杂志,2006,21(6):375-377
[13] 王锦惠,于子芳,闫芳,等.经阴道二维及三维超声对体外受精- 胚胎移植子宫内膜容受性的评估价值[J/CD].中华医学超声杂志:电子版,2015,12(4):319-324
[14] Gonen Y,Casper RF,Jacobson W.Endometrial thickness and growth during ovarian stimulation:a possible predictor of implantation in in vitro fertilization[J].Fertil Steril,1989,52 (3):446-450
[15] Zhang T,Li Z,Ren X,et al.Endometrial thickness as a predictor of the reproductive outcomes in fresh and frozen embryo transfer cycles:a retrospective cohort study of 1512 IVF cycles with morphologically good-quality blastocyst[J].Med,2018,97(4):e9689
[16] Kuijsters NPM,Methorst WG,Kortenhorst MSQ,et al.Uterine peristalsis and fertility:current knowledge and future perspectives:a review and meta-analysis[J].ReprodBiomed Online,2017,35(1):50-71
[17] Prasad S,Goyal R,Kumar Y,et al.The relationship between uterine artery two-dimensional color doppler measurement and pregnancy outcome:a prospective observational study[J].J Reprod Infertil,2017,18(2):251-256
[18] Chien LW,Au HK,Chen PL,et al.Assessment of uterine receptivity by the endometrial-subendometrial blood flow distribution pattern in women undergoing in vitro fertilization-embryo transfer[J].Fertil Steril,2012,78(2):245-251
[19] Kupesic S,Bekavac I,Bjelos D,et al.Assessment of endometrial receptivity by transvaginal color Doppler and three-dimensional power Doppler ultrasonography in patients underging in-vitro fertilization procedures[J].Ultrasound Med,2001,20(2):125-134
[20] Wang J,Xia F,Zhou Y,et al.Association between endometrial /subendometrial vasculature and embryo transfer outcome:a meta-analysis and subgroup analysis[J].JUltrasound Med,2018,37(1):149-163