Abstract：
OBJECTIVE: To prospectively examine the association between adenomyosis type, location, and severity with reproductive outcomes in patients undergoing single embryo transfer (SET) with embryos derived from donor oocytes.
METHODS: A prospective observational cohort study.
METHODS: University-affiliated in vitro fertilization center.
METHODS: Patients with infertility with (n = 114) and without (n = 114) adenomyosis who received their first donor oocyte transfer between January 2019 and January 2023 were included in this study.
METHODS: Adenomyosis was confirmed with the presence of at least one direct feature visualized by 2- or 3-dimensional transvaginal ultrasound and classified according to type (diffuse or focal), localization (inner or outer myometrium and/or junctional zone [JZ]), and uterine extension (mild, moderate, or severe). After an artificial or natural endometrial preparation cycle, patients underwent SET in the blastocyst stage.
METHODS: The primary outcome was the implantation rate. The secondary outcomes were the clinical pregnancy, live birth, and miscarriage rates after SET.
RESULTS: The presence of adenomyosis did not significantly affect the implantation, clinical pregnancy, or live birth rates. However, women with adenomyosis had a significantly higher miscarriage rate than those without adenomyosis (35.4% vs. 18.1%, respectively). The multivariate analysis assessed possible risk factors for each clinical outcome considered in the study and showed that adenomyosis affected the risk of miscarriage. Specifically, transvaginal sonography detection of adenomyosis in the JZ was associated with over threefold higher relative risk of miscarriage (relative risk [RR], 3.28; 95% confidence interval [CI], 1.38-7.78). Conversely, adenomyosis features detected exclusively in the outer myometrium were associated with a higher ongoing pregnancy rate (RR, 0.30; 95% CI, 0.13-0.72). Diffuse adenomyosis in the JZ and severe adenomyosis increased the relative risk of miscarriage two-fold (RR, 2.29; 95% CI, 1.22-4.30 and RR, 2.20; 95% CI, 1.19-4.04, respectively).
CONCLUSIONS: This study demonstrated that although adenomyosis did not significantly reduce the odds of implantation, the direct signs of adenomyosis in the JZ and disease severity are significant risk factors for miscarriage in patients receiving donor oocyte transfers. This study highlights the importance of thorough ultrasound examination and detailed adenomyosis classification in the assessment and management of patients with infertility.
METHODS: A prospective observational cohort study.
METHODS: University-affiliated in vitro fertilization center.
METHODS: Patients with infertility with (n = 114) and without (n = 114) adenomyosis who received their first donor oocyte transfer between January 2019 and January 2023 were included in this study.
METHODS: Adenomyosis was confirmed with the presence of at least one direct feature visualized by 2- or 3-dimensional transvaginal ultrasound and classified according to type (diffuse or focal), localization (inner or outer myometrium and/or junctional zone [JZ]), and uterine extension (mild, moderate, or severe). After an artificial or natural endometrial preparation cycle, patients underwent SET in the blastocyst stage.
METHODS: The primary outcome was the implantation rate. The secondary outcomes were the clinical pregnancy, live birth, and miscarriage rates after SET.
RESULTS: The presence of adenomyosis did not significantly affect the implantation, clinical pregnancy, or live birth rates. However, women with adenomyosis had a significantly higher miscarriage rate than those without adenomyosis (35.4% vs. 18.1%, respectively). The multivariate analysis assessed possible risk factors for each clinical outcome considered in the study and showed that adenomyosis affected the risk of miscarriage. Specifically, transvaginal sonography detection of adenomyosis in the JZ was associated with over threefold higher relative risk of miscarriage (relative risk [RR], 3.28; 95% confidence interval [CI], 1.38-7.78). Conversely, adenomyosis features detected exclusively in the outer myometrium were associated with a higher ongoing pregnancy rate (RR, 0.30; 95% CI, 0.13-0.72). Diffuse adenomyosis in the JZ and severe adenomyosis increased the relative risk of miscarriage two-fold (RR, 2.29; 95% CI, 1.22-4.30 and RR, 2.20; 95% CI, 1.19-4.04, respectively).
CONCLUSIONS: This study demonstrated that although adenomyosis did not significantly reduce the odds of implantation, the direct signs of adenomyosis in the JZ and disease severity are significant risk factors for miscarriage in patients receiving donor oocyte transfers. This study highlights the importance of thorough ultrasound examination and detailed adenomyosis classification in the assessment and management of patients with infertility.
摘要：
目的：前瞻性研究子宫腺肌病类型，location,以及使用供体卵母细胞来源的胚胎进行单胚胎移植（SET）的患者的生殖结局的严重程度。
方法：一项前瞻性观察性队列研究。
方法：大学附属体外受精中心。
方法：在2019年1月至2023年1月期间接受首次供体卵母细胞移植的患有（n=114）和没有（n=114）子宫腺肌病的不孕患者被纳入研究。
方法：通过2D/3D经阴道超声显示至少一个直接特征，证实了子宫腺肌病，并根据类型(弥漫性，焦点)，定位（内/外子宫肌层和/或交界区）和子宫延伸（轻度，中度,严重)。在人工或天然子宫内膜准备周期后，患者在囊胚期接受SET。
方法：主要结果是植入率。次要结局是临床妊娠，活产,和流产率遵循SET。
结果：（s）：子宫腺肌病的存在并没有显着影响种植，临床妊娠,或活产率。然而,与没有子宫腺肌病的女性相比，子宫腺肌病的流产率明显更高（20.2%vs.9.6%,分别为；p=0.04)。多变量分析评估了研究中考虑的每种临床结果的可能危险因素，并显示子宫腺肌病影响流产的风险。具体来说,TVS在交界区检测子宫腺肌病与流产几率高三倍以上相关(RR3.28,95%CI1.38-7.78;p=0.004)。相反，仅在子宫外肌层中检测到的子宫腺肌病特征与更高的持续妊娠相关(RR0.30,95%CI0.13-0.72;p=0.004)。JZ中的弥漫性子宫腺肌病和严重子宫腺肌病使流产的几率增加了四倍（RR2.29，95％CI1.22-4.30；p=0.015；RR2.20，95％CI1.19-4.04；p=0.005）。
结论：（s）：这项研究表明，虽然子宫腺肌病并没有显着降低植入的几率，交界处子宫腺肌病的直接征象和疾病的严重程度是接受供体卵母细胞移植的患者流产的重要危险因素。这项研究强调了彻底的超声检查和详细的子宫腺肌病分类在评估和治疗不育患者中的重要性。
方法：一项前瞻性观察性队列研究。
方法：大学附属体外受精中心。
方法：在2019年1月至2023年1月期间接受首次供体卵母细胞移植的患有（n=114）和没有（n=114）子宫腺肌病的不孕患者被纳入研究。
方法：通过2D/3D经阴道超声显示至少一个直接特征，证实了子宫腺肌病，并根据类型(弥漫性，焦点)，定位（内/外子宫肌层和/或交界区）和子宫延伸（轻度，中度,严重)。在人工或天然子宫内膜准备周期后，患者在囊胚期接受SET。
方法：主要结果是植入率。次要结局是临床妊娠，活产,和流产率遵循SET。
结果：（s）：子宫腺肌病的存在并没有显着影响种植，临床妊娠,或活产率。然而,与没有子宫腺肌病的女性相比，子宫腺肌病的流产率明显更高（20.2%vs.9.6%,分别为；p=0.04)。多变量分析评估了研究中考虑的每种临床结果的可能危险因素，并显示子宫腺肌病影响流产的风险。具体来说,TVS在交界区检测子宫腺肌病与流产几率高三倍以上相关(RR3.28,95%CI1.38-7.78;p=0.004)。相反，仅在子宫外肌层中检测到的子宫腺肌病特征与更高的持续妊娠相关(RR0.30,95%CI0.13-0.72;p=0.004)。JZ中的弥漫性子宫腺肌病和严重子宫腺肌病使流产的几率增加了四倍（RR2.29，95％CI1.22-4.30；p=0.015；RR2.20，95％CI1.19-4.04；p=0.005）。
结论：（s）：这项研究表明，虽然子宫腺肌病并没有显着降低植入的几率，交界处子宫腺肌病的直接征象和疾病的严重程度是接受供体卵母细胞移植的患者流产的重要危险因素。这项研究强调了彻底的超声检查和详细的子宫腺肌病分类在评估和治疗不育患者中的重要性。
