目的:探讨体外受精/卵胞浆内单精子注射(IVF/ICSI)子宫生态位与生殖结局的关系。
方法:同济医院生殖医学中心的回顾性队列研究,武汉,中国。
方法:在2015年1月至2019年12月期间,共有2449名有剖宫产史的妇女接受了2874个IVF/ICSI周期。
方法:在三维(3D)经阴道超声检查(TVS)下深度超过2mm或在宫腔镜下可见的缺损被定义为子宫小生境。首次胚胎移植的IVF/ICSI结果是通过电话采访1年获得的,无论新鲜胚胎还是冻融胚胎。广义估计方程(GEE),逻辑回归分析,和倾向评分匹配用于阐明子宫生态位与IVF/ICSI结局之间的关系.
方法:主要结局是活产率。次要结果是人绒毛膜促性腺激素(hCG)测试结果阳性,临床妊娠率,植入率,流产率和异位妊娠率。
结果:排除48个子宫畸形周期后,18个周期的染色体异常,没有可用胚胎或没有胚胎移植的281个周期,5个周期的卵母细胞捐献和7个周期的随访失败,我们最终纳入了2231名女性,共2515个周期的研究.与没有利基的女性相比,利基女性活产率降低(18.99%vs.31.51%,调整后OR:0.51,95%CI:0.34-0.77),hCG试验阳性率(34.08%vs.46.40%,调整后OR:0.61,95%CI:0.43-0.87),临床妊娠率(29.05%vs.42.25%,校正OR:0.57,95%CI:0.39-0.82)和植入率(25.87%vs.36.95%,校正OR:0.53,95%CI:0.38-0.76)。在所有的敏感性分析中,利基组的流产率增加了7.28%-18.22%,即使并非所有流产均具有统计学意义。
结论:子宫小生境可能对有剖宫产史的妇女进行IVF/ICSI治疗后的生育能力产生不利影响。从业人员应注意,患有子宫壁龛的女性可能与不良的IVF/ICSI结局有关。
To investigate the relationship between uterine niche and reproductive outcomes of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI).
A retrospective cohort study.
A reproductive medicine center.
A total of 2,449 women with cesarean section history who underwent 2,874 IVF/ICSI cycles between January 2015 and December 2019.
A defect deeper than 2 mm visible under three-dimensional transvaginal sonography or hysteroscopy was defined as uterine niche. The IVF/ICSI outcomes of the first embryo transfer were obtained by telephone interview 1 year after embryo transfer regardless of fresh embryos or frozen-thawed embryos. Generalized estimating equations, logistic regression analyses, and propensity score matching were applied to clarify the relationship between uterine niche and IVF/ICSI outcomes.
Primary outcome was live birth rate. Secondary outcomes were positive human chorionic gonadotropin test results, clinical pregnancy rate, implantation rate, miscarriage rate, and ectopic pregnancy rate.
After excluding 48 cycles for uterine malformation; 18 cycles for chromosome abnormality; 281 cycles for no available embryo or no embryo transfer; 5 cycles for oocyte donation; and 7 cycles for loss of follow-up, we finally included 2,231 women with 2,515 cycles in our study. Compared with women without niche, women with niche had reduced live birth rate (18.99% vs. 31.51%, : 0.51, 95% CI: 0.34-0.77), positive human chorionic gonadotropin test rate (34.08% vs. 46.40%, adjusted odds ratio [aOR]: 0.61, 95% confidence interval [CI]: 0.43-0.87), clinical pregnancy rate (29.05% vs. 42.25%, aOR: 0.57, 95% CI: 0.39-0.82) and implantation rate (25.87% vs. 36.95%, aOR: 0.53, 95% CI: 0.38-0.76). In all the sensitivity analyses, the niche group had a 7.28% to 18.22% increase in miscarriage rate even not all of them were statistically significant.
Uterine niche may have a detrimental effect on subsequent fertility of women with cesarean section history undergoing IVF/ICSI treatment. Practitioners should be noted that women with uterine niches may be associated with adverse IVF/ICSI outcomes.