目的:比较经宫颈粘连切除术(TCRA)后患者与子宫形态正常患者冻融胚胎移植(FET)的妊娠和围产期结局,探讨TCRA术后FET患者妊娠结局的影响因素。
方法:我们回顾性分析了2014年9月至2023年9月的FET周期,将子宫形态正常的患者与接受TCRA治疗的宫腔粘连(IUAs)患者进行比较。针对混杂因素调整的倾向得分匹配(PSM)。LASSO回归和多变量逻辑回归确定了结果的预测因子,在列线图中直观地表示。使用校准曲线评估模型性能,ROC曲线,和DCA,使用引导方法进行内部验证。
结果:PSM后分析显示,临床妊娠后子宫形态正常的患者活产率较高(75.1%vs.61.7%,P<0.001)。两组之间的临床妊娠率和围产期结局没有显着差异。影响TCRA术后FET临床妊娠的因素包括基础孕酮水平,子宫内膜厚度,奇偶校验,不孕的原因,胚胎移植阶段,移植胚胎的数量和质量,IUA严重性,和TCRA外科手术。身体质量指数,基础LH水平,胚胎移植后第14天的HCG水平是活产结局的决定因素.
结论:TCRA后的FET周期显示较低的成功活产率,但TCRA并未增加不良围产期结局风险.我们的研究引入了一种创新的预测模型,用于TCRA后接受FET的患者的临床妊娠和活产结局,解决现有研究中的一个重大空白。
OBJECTIVE: To compare the pregnancy and perinatal outcomes of frozen-thawed embryo transfer (FET) in patients following transcervical resection of adhesions (TCRA) versus patients with normal uterine morphology, and to investigate the factors influencing pregnancy outcomes in patients undergoing FET after TCRA.
METHODS: We retrospectively analyzed FET cycles from September 2014 to September 2023, comparing patients with normal uterine morphology to those with intrauterine adhesions (IUAs) treated with TCRA. Propensity score matching (PSM) adjusted for confounding factors. LASSO regression and multivariate logistic regression identified predictors of outcomes, which were visually represented in nomograms. Model performance was assessed using calibration curves, ROC curves, and DCA, with bootstrap method for internal validation.
RESULTS: Post-PSM analysis showed higher live birth rates in patients with normal uterine morphology after clinical pregnancy (75.1% vs. 61.7%, P < 0.001). No significant differences were noted in clinical pregnancy rates and perinatal outcomes between the groups. Factors influencing clinical pregnancy in FET after TCRA included basal progesterone levels, endometrial thickness, parity, infertility cause, embryo stage at transfer, number and quality of embryos transferred, IUA severity, and TCRA surgical procedures. Body mass index, basal LH levels, and day 14 HCG levels post-embryo transfer were determinants of live birth outcome.
CONCLUSIONS: FET cycles following TCRA showed a lower rate of successful live births, but TCRA did not increase adverse perinatal outcome risks. Our study introduces an innovative predictive model for clinical pregnancy and live birth outcomes in patients undergoing FET following TCRA, addressing a significant void in existing research.